Provider Demographics
NPI:1942744255
Name:VASQUEZ, CHRISTINA DENISE
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:DENISE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 GALVESTON ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-4638
Mailing Address - Country:US
Mailing Address - Phone:956-568-4571
Mailing Address - Fax:956-568-4671
Practice Address - Street 1:1301 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5343
Practice Address - Country:US
Practice Address - Phone:956-724-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189063183700000X
TX381572355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant