Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 0104555757 | VA |
NPI | 1407061674 |
---|---|
Provider Name | Dr. Maribel Vazquez |
First Address | Sterling, VA 20165-6145 |
Second Address | Sterling, VA 20165-6149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 15/05/2008 |