Provider Demographics
NPI:1003690694
Name:VAZQUEZ QUESADA, ANGEL LUIS
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LUIS
Last Name:VAZQUEZ QUESADA
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 1:7195 NW 179TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6121
Mailing Address - Country:US
Mailing Address - Phone:305-877-4687
Mailing Address - Fax:
Practice Address - Street 1:7195 NW 179TH ST APT 104
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6121
Practice Address - Country:US
Practice Address - Phone:305-877-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-290163106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician