Provider Demographics
NPI:1730878661
Name:VASQUEZ, ROXANA AMPARO
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:AMPARO
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 1:1500 MERIDIAN PL NW APT 410
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3053
Mailing Address - Country:US
Mailing Address - Phone:202-751-7208
Mailing Address - Fax:
Practice Address - Street 1:1500 MERIDIAN PL NW APT 410
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3053
Practice Address - Country:US
Practice Address - Phone:202-751-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2453181172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver