Provider Demographics
NPI:1811314875
Name:VAZQUEZ-GUERRA, MARICEL (SPEECH AND LANGUAGE)
Entity type:Individual
Prefix:
First Name:MARICEL
Middle Name:
Last Name:VAZQUEZ-GUERRA
Suffix:
Gender:F
Credentials:SPEECH AND LANGUAGE
Other - Prefix:
Other - First Name:MARICEL
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 W 49TH ST STE 332
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3489
Mailing Address - Country:US
Mailing Address - Phone:305-556-0121
Mailing Address - Fax:305-556-1372
Practice Address - Street 1:15291 NW 60TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-549-8876
Practice Address - Fax:305-549-8877
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA146432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant