Provider Demographics
NPI:1386969087
Name:VASQUEZ, RAIDY G
Entity type:Individual
Prefix:
First Name:RAIDY
Middle Name:G
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 1:1490 W 49TH PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3148
Mailing Address - Country:US
Mailing Address - Phone:305-823-4008
Mailing Address - Fax:305-823-4009
Practice Address - Street 1:1490 W 49TH PL
Practice Address - Street 2:SUITE 210
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3148
Practice Address - Country:US
Practice Address - Phone:305-823-4008
Practice Address - Fax:305-823-4009
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist