Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 21-1664 | AZ |
NPI | 1063174852 |
---|---|
Provider Name | Gerardo Vazquez |
First Address | Phoenix, AZ 85040-3612 |
Second Address | Phoenix, AZ 85040-3612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2021 |
Last Update Date | 08/10/2021 |