Individual
MARIO VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2451 S AVENUE A STE A104, YUMA, AZ 85364-7189
(928) 336-2165
Mailing address
2400 S AVENUE A, YUMA, AZ 85364
(928) 344-2000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
234060
AZ
363LA2100X
Acute Care Nurse Practitioner
234060
AZ
363LG0600X
Gerontology Nurse Practitioner
234060
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600512
—
AZ
Enumeration date
09/04/2019
Last updated
05/11/2020
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