Provider Demographics
NPI:1730798380
Name:VASQUEZ MARTI, EVA C
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:C
Last Name:VASQUEZ MARTI
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 1:106 LAGO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5802
Mailing Address - Country:US
Mailing Address - Phone:305-962-6297
Mailing Address - Fax:
Practice Address - Street 1:106 LAGO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5802
Practice Address - Country:US
Practice Address - Phone:305-962-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW164411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical