1730943721 NPI number — LUZ STELLA VASQUEZ

Table of content: LUZ STELLA VASQUEZ (NPI 1730943721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730943721 NPI number — LUZ STELLA VASQUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VASQUEZ
Provider First Name:
LUZ
Provider Middle Name:
STELLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730943721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9292 LAKESIDE LN # 9292
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33437-2857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-669-0011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5875 LAKE WORTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33463-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
959-546-6900
Provider Business Practice Location Address Fax Number:
561-847-4574
Provider Enumeration Date:
02/09/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA77693 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)