Provider Demographics
NPI:1104573583
Name:VAZQUEZ FERRIOL, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:VAZQUEZ FERRIOL
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 1:6619 SW 116TH PL APT G
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1778
Mailing Address - Country:US
Mailing Address - Phone:786-707-0878
Mailing Address - Fax:
Practice Address - Street 1:6619 SW 116TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1734
Practice Address - Country:US
Practice Address - Phone:786-707-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-134989106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113583200Medicaid