Provider Demographics
NPI:1588461289
Name:VAZQUEZ GALLARDO, TANIA PAOLA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:PAOLA
Last Name:VAZQUEZ GALLARDO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 GROSS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1515
Mailing Address - Country:US
Mailing Address - Phone:307-287-3772
Mailing Address - Fax:
Practice Address - Street 1:5845 GROSS DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1515
Practice Address - Country:US
Practice Address - Phone:307-287-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health