Provider Demographics
NPI:1649986969
Name:VAZQUEZ, ERIN TERESA (MASTER CERTIFIED)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:TERESA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MASTER CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 MAGNOLIA CURV
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2133
Mailing Address - Country:US
Mailing Address - Phone:720-427-2112
Mailing Address - Fax:
Practice Address - Street 1:1036 MAGNOLIA CURV
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2133
Practice Address - Country:US
Practice Address - Phone:720-427-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH3586174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist