Provider Demographics
NPI:1427656842
Name:VASQUEZ VARGAS, DANIEL (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:VASQUEZ VARGAS
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 COUNCIL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3253
Mailing Address - Country:US
Mailing Address - Phone:914-426-8015
Mailing Address - Fax:
Practice Address - Street 1:7509 COUNCIL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3253
Practice Address - Country:US
Practice Address - Phone:914-426-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9144268015OtherN/A