Individual
LIBRADA TERESA VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 GRANT ST, GARY, IN 46402-6001
(219) 886-4573
Mailing address
PO BOX 660267, INDIANAPOLIS, IN 46266-0001
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01037861A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383417
ANTHEM BCBS
IN
Enumeration date
01/26/2006
Last updated
10/11/2007
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