Provider Demographics
NPI:1962033506
Name:ARCE-VAZQUEZ, KARLA MARIE
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MARIE
Last Name:ARCE-VAZQUEZ
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 1:6111 171ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2023
Mailing Address - Country:US
Mailing Address - Phone:646-752-7335
Mailing Address - Fax:
Practice Address - Street 1:6111 171ST ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2023
Practice Address - Country:US
Practice Address - Phone:646-752-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY411386883OtherDRIVERS LICENSE