Provider Demographics
NPI:1881348282
Name:CORA VAZQUEZ, KARLA YADIZ
Entity type:Individual
Prefix:
First Name:KARLA YADIZ
Middle Name:
Last Name:CORA VAZQUEZ
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:PO BOX 1378
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-1378
Mailing Address - Country:US
Mailing Address - Phone:337-424-3365
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE ARIZONA 2
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2835
Practice Address - Country:US
Practice Address - Phone:337-424-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR259071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty