Provider Demographics
NPI:1942714621
Name:VASQUEZ, GISELLE (CNA)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:GISELLE
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:9257 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2109
Mailing Address - Country:US
Mailing Address - Phone:520-631-3562
Mailing Address - Fax:
Practice Address - Street 1:9400 E VALLARTA TRL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-8159
Practice Address - Country:US
Practice Address - Phone:520-631-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty