1750637492 NPI number — MRS. ZENAIDA VASQUEZ-JOHNSON R.D.H. / L.P.N

Table of content: MRS. ZENAIDA VASQUEZ-JOHNSON R.D.H. / L.P.N (NPI 1750637492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750637492 NPI number — MRS. ZENAIDA VASQUEZ-JOHNSON R.D.H. / L.P.N

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VASQUEZ-JOHNSON
Provider First Name:
ZENAIDA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.H. / L.P.N
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VASQUEZ
Provider Other First Name:
ZENAIDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.H. / LPN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750637492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/01/2012
NPI Reactivation Date:
05/12/2014

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 HORTON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N. MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-744-2387
Provider Business Mailing Address Fax Number:
231-744-2387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 HORTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N. MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-744-2387
Provider Business Practice Location Address Fax Number:
231-744-2387
Provider Enumeration Date:
07/31/2012

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: 124Q00000X , with the licence number:  2902005276 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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