Provider Demographics
NPI:1215661129
Name:VASQUEZ, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VASQUEZ
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:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-0708
Mailing Address - Country:US
Mailing Address - Phone:304-646-0267
Mailing Address - Fax:
Practice Address - Street 1:1156 RD BAILEY HWY
Practice Address - Street 2:THOMPSON COURT LOT 21
Practice Address - City:MULLENSVILLE
Practice Address - State:WV
Practice Address - Zip Code:24818
Practice Address - Country:US
Practice Address - Phone:304-646-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant