Provider Demographics
NPI:1588362263
Name:GONZALES VASQUEZ, ARANTXA L
Entity type:Individual
Prefix:
First Name:ARANTXA
Middle Name:L
Last Name:GONZALES VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARANTXA
Other - Middle Name:L
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:815 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2117
Mailing Address - Country:US
Mailing Address - Phone:253-396-5073
Mailing Address - Fax:
Practice Address - Street 1:815 S PEARL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-2117
Practice Address - Country:US
Practice Address - Phone:253-396-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist