Provider Demographics
NPI:1063174852
Name:VAZQUEZ, GERARDO (ND)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 S 27TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3612
Mailing Address - Country:US
Mailing Address - Phone:602-358-4152
Mailing Address - Fax:
Practice Address - Street 1:5820 S 27TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3612
Practice Address - Country:US
Practice Address - Phone:602-358-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1664175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath