Provider Demographics
NPI:1730530205
Name:VASQUEZ, ESTRELLA
Entity type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 W 189TH ST
Mailing Address - Street 2:APT 20
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4112
Mailing Address - Country:US
Mailing Address - Phone:917-488-7408
Mailing Address - Fax:
Practice Address - Street 1:652 W 189TH ST
Practice Address - Street 2:APT 20
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4112
Practice Address - Country:US
Practice Address - Phone:917-488-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator