Provider Demographics
NPI:1487365581
Name:VAZQUEZ, KARINA
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:VAZQUEZ
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 1:13140 BUGAMBILIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ELIZARIO
Mailing Address - State:TX
Mailing Address - Zip Code:79849-8641
Mailing Address - Country:US
Mailing Address - Phone:915-305-5674
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8122
Practice Address - Country:US
Practice Address - Phone:915-271-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22245874106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst