1073608261 NPI number — ROBERT A VASQUEZ D.C.

Table of content: ROBERT A VASQUEZ D.C. (NPI 1073608261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073608261 NPI number — ROBERT A VASQUEZ D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VASQUEZ
Provider First Name:
ROBERT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1073608261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 CHEEK SPARGER
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-267-0102
Provider Business Mailing Address Fax Number:
817-283-4755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 CHEEK SPARGER
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-267-0102
Provider Business Practice Location Address Fax Number:
817-283-4755
Provider Enumeration Date:
10/04/2006

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: 111N00000X , with the licence number:  DC7892 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 605815 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com