Provider Demographics
NPI:1366122525
Name:VAZQUEZ, HECTOR RAFAEL
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:RAFAEL
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10217 W COUNTRY CLUB TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2729
Mailing Address - Country:US
Mailing Address - Phone:623-850-6891
Mailing Address - Fax:
Practice Address - Street 1:10217 W COUNTRY CLUB TRL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2729
Practice Address - Country:US
Practice Address - Phone:623-850-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ295150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily