Provider Demographics
NPI:1295577823
Name:VASQUEZ, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 SW 80TH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-3206
Mailing Address - Country:US
Mailing Address - Phone:754-242-5551
Mailing Address - Fax:
Practice Address - Street 1:961 SW 80TH AVE APT B
Practice Address - Street 2:
Practice Address - City:N LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-3206
Practice Address - Country:US
Practice Address - Phone:754-242-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician