Provider Demographics
NPI:1356927420
Name:VASQUEZ ARISTIZABAL, NAYIBE (SA-C)
Entity type:Individual
Prefix:
First Name:NAYIBE
Middle Name:
Last Name:VASQUEZ ARISTIZABAL
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 127TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1927
Mailing Address - Country:US
Mailing Address - Phone:347-545-8649
Mailing Address - Fax:
Practice Address - Street 1:923 127TH ST APT 2
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1927
Practice Address - Country:US
Practice Address - Phone:347-545-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19-425246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant