Individual
CARISSA I VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
104 THIRD ST, NEW CITY, NY 10956-5929
(845) 323-0489
Mailing address
104 THIRD ST, NEW CITY, NY 10956-5929
(845) 323-0489
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015008
NY
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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