Provider Demographics
NPI:1902347586
Name:VASQUEZ, LESTER JOSUE
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:JOSUE
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6295 SW 151ST PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2738
Mailing Address - Country:US
Mailing Address - Phone:305-322-2131
Mailing Address - Fax:
Practice Address - Street 1:6295 SW 151ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2738
Practice Address - Country:US
Practice Address - Phone:305-322-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018195300Medicaid