Provider Demographics
NPI:1205090172
Name:BERALDO A VAZQUEZ CORREA MD LTD
Entity type:Organization
Organization Name:BERALDO A VAZQUEZ CORREA MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERALDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAZQUEZ CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-464-8807
Mailing Address - Street 1:2764 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE# 376
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2120
Mailing Address - Country:US
Mailing Address - Phone:702-464-8807
Mailing Address - Fax:702-968-8637
Practice Address - Street 1:2764 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE# 376
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2120
Practice Address - Country:US
Practice Address - Phone:702-464-8807
Practice Address - Fax:702-968-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty