Provider Demographics
NPI:1932850120
Name:VASQUEZ, MARIO ERNESTO JR
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ERNESTO
Last Name:VASQUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9608 WOODROW WILSON DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-8430
Mailing Address - Country:US
Mailing Address - Phone:858-837-3604
Mailing Address - Fax:
Practice Address - Street 1:9608 WOODROW WILSON DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-8430
Practice Address - Country:US
Practice Address - Phone:858-837-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT135676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist