Provider Demographics
NPI:1295480358
Name:VAZQUEZ, JOSE LUIS (PA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 E 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5587
Mailing Address - Country:US
Mailing Address - Phone:956-447-5557
Mailing Address - Fax:
Practice Address - Street 1:1604 E 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5587
Practice Address - Country:US
Practice Address - Phone:956-447-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty