Provider Demographics
NPI:1023649431
Name:VAZQUEZ SERRA, CARLA DEYANIRA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:DEYANIRA
Last Name:VAZQUEZ SERRA
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 1:9385 FM 244 RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:77830-5620
Mailing Address - Country:US
Mailing Address - Phone:979-777-5466
Mailing Address - Fax:
Practice Address - Street 1:9385 FM 244 RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:TX
Practice Address - Zip Code:77830-5620
Practice Address - Country:US
Practice Address - Phone:979-777-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer