Provider Demographics
NPI:1730943721
Name:VASQUEZ, LUZ STELLA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:STELLA
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 1:9292 LAKESIDE LN # 9292
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2857
Mailing Address - Country:US
Mailing Address - Phone:954-669-0011
Mailing Address - Fax:
Practice Address - Street 1:5875 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3209
Practice Address - Country:US
Practice Address - Phone:959-546-6900
Practice Address - Fax:561-847-4574
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist