Provider Demographics
NPI:1134596372
Name:VAZQUEZ, YANITZA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:YANITZA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3622
Mailing Address - Country:US
Mailing Address - Phone:954-217-6326
Mailing Address - Fax:
Practice Address - Street 1:2900 S COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3622
Practice Address - Country:US
Practice Address - Phone:954-217-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13823283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010060900Medicaid