Provider Demographics
NPI:1245621390
Name:VAZQUEZ, SERAIDA LUCY (LMT,)
Entity type:Individual
Prefix:MS
First Name:SERAIDA
Middle Name:LUCY
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LMT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO. BOX 154
Mailing Address - Street 2:
Mailing Address - City:BIRCH BAY
Mailing Address - State:WA
Mailing Address - Zip Code:98231
Mailing Address - Country:US
Mailing Address - Phone:360-820-8777
Mailing Address - Fax:
Practice Address - Street 1:7620 BIRCH BAY DRIVE
Practice Address - Street 2:
Practice Address - City:BIRCH BAY
Practice Address - State:WA
Practice Address - Zip Code:98230
Practice Address - Country:US
Practice Address - Phone:360-820-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60080578225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist