Provider Demographics
NPI:1992285142
Name:VAZQUEZ, AIDA LUZ
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:LUZ
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 WILLOW BEACH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1436
Mailing Address - Country:US
Mailing Address - Phone:281-933-0058
Mailing Address - Fax:
Practice Address - Street 1:3640 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3016
Practice Address - Country:US
Practice Address - Phone:281-778-5144
Practice Address - Fax:281-778-5149
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102533225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology