Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1447403282 |
---|---|
Provider Name | Miss Rosa M Vazquez |
First Address | Hines, IL 60141-3030 |
Second Address | Hines, IL 60141-3030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2008 |
Last Update Date | 24/10/2008 |