Provider Demographics
NPI:1366957250
Name:VAZQUEZ, FRANCISCO Q
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:Q
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 FORT MELLON CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2446
Mailing Address - Country:US
Mailing Address - Phone:646-824-5102
Mailing Address - Fax:
Practice Address - Street 1:2232 FORT MELLON CT
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-2446
Practice Address - Country:US
Practice Address - Phone:646-824-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL17000242319343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)