Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 68181 | MN |
Y | 2084N0402X | Child Neurologist | 68181 | MN |
NPI | 1003378902 |
---|---|
Provider Name | Alejandra Catalina Vasquez Avila |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 01/07/2021 |