Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP127689 | TX |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP127689 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP127689 | TX |
NPI | 1073991485 |
---|---|
Provider Name | Joe Louis Vasquez JR. |
First Address | Bay City, TX 77414-5128 |
Second Address | Bay City, TX 77414-7107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 19/10/2015 |