Provider Demographics
NPI:1306066964
Name:TROYANO-VAZQUEZ, NICOLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:TROYANO-VAZQUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1415
Mailing Address - Country:US
Mailing Address - Phone:215-624-1300
Mailing Address - Fax:215-624-7339
Practice Address - Street 1:2833 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1415
Practice Address - Country:US
Practice Address - Phone:215-624-1300
Practice Address - Fax:215-624-7339
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016233103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling