Provider Demographics
NPI:1457897712
Name:VAZQUEZ, JOSE ALBERTO (RBT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALBERTO
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 NW 80TH CT APT 2528
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2234
Mailing Address - Country:US
Mailing Address - Phone:786-371-5162
Mailing Address - Fax:
Practice Address - Street 1:10000 NW 80TH CT APT 2528
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2234
Practice Address - Country:US
Practice Address - Phone:786-371-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician