Provider Demographics
NPI:1144701699
Name:VAZQUEZ, GABRIEL JR (LVN)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:VAZQUEZ
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CAPPS DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7521
Mailing Address - Country:US
Mailing Address - Phone:936-526-1567
Mailing Address - Fax:
Practice Address - Street 1:302 CAPPS DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7521
Practice Address - Country:US
Practice Address - Phone:936-526-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336700164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse