Provider Demographics
NPI:1306250014
Name:VASQUEZ, ROSA (RMFTI)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11996 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4371
Mailing Address - Country:US
Mailing Address - Phone:754-422-7030
Mailing Address - Fax:
Practice Address - Street 1:2220 NW 145TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2866
Practice Address - Country:US
Practice Address - Phone:754-422-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X, 222Q00000X
FLIMT 1886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist