Provider Demographics
NPI:1396167417
Name:VASQUEZ, JUAN E (RRT)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:E
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 COLIMA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5908
Mailing Address - Country:US
Mailing Address - Phone:210-685-9730
Mailing Address - Fax:
Practice Address - Street 1:1515 COLIMA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5908
Practice Address - Country:US
Practice Address - Phone:210-685-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52515227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered