Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 0101052517 | VA |
NPI | 1003995168 |
---|---|
Provider Name | Betsy Vasquez |
First Address | Sterling, VA 20165-5877 |
Second Address | Sterling, VA 20165-5877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |