Provider Demographics
NPI:1962940320
Name:VAZQUEZ, RICARDO FELIX (PTA, NREMT)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:FELIX
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PTA, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SPRUCE PL
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4871
Mailing Address - Country:US
Mailing Address - Phone:651-788-2881
Mailing Address - Fax:
Practice Address - Street 1:2300 SPRUCE PL
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-4871
Practice Address - Country:US
Practice Address - Phone:651-788-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNE3018291146N00000X
MNA1957225200000X
TX2115596225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic