Provider Demographics
NPI:1831580489
Name:VASQUEZ HERNANDEZ, DEISI
Entity type:Individual
Prefix:
First Name:DEISI
Middle Name:
Last Name:VASQUEZ HERNANDEZ
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 1:3237 N GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4013
Mailing Address - Country:US
Mailing Address - Phone:720-545-6167
Mailing Address - Fax:
Practice Address - Street 1:7200 S ALTON WAY
Practice Address - Street 2:STE C-250
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2206
Practice Address - Country:US
Practice Address - Phone:877-489-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012136225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant