Individual
BANESA KASSANDRA VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1400 BRYAN DR STE 201, DURANT, OK 74701-2157
(580) 924-3080
Mailing address
2804 CASSIE RD, MANSFIELD, TX 76063-4269
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0549R
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2022
Last updated
06/09/2023
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