Provider Demographics
NPI:1972595304
Name:VASQUEZ, BERTHA (FNP)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N OREGON ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3170
Mailing Address - Country:US
Mailing Address - Phone:915-534-2531
Mailing Address - Fax:915-532-2094
Practice Address - Street 1:2600 N OREGON ST
Practice Address - Street 2:SUITE 800
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3170
Practice Address - Country:US
Practice Address - Phone:915-534-2531
Practice Address - Fax:915-532-2094
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N3332OtherBC/BS
TX85434OtherPRESBYTERIAN SALUD
TX79751032OtherCONSULTEC
TX81438601Medicaid
TX8N3332OtherBC/BS
TX81438601Medicaid