Provider Demographics
NPI:1720422298
Name:VASQUEZ, MARIA JULIANA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JULIANA
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 1:5047 BRADLEY BLVD
Mailing Address - Street 2:APT 4
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6544
Mailing Address - Country:US
Mailing Address - Phone:240-620-8892
Mailing Address - Fax:
Practice Address - Street 1:4301 N FEDERAL HWY
Practice Address - Street 2:SUITE 2 SOUTH
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6519
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:954-342-0273
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist