Individual
DR. ILEAN MARIEL VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
859 S 4TH AVE, BRIGHTON, CO 80601-3205
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0073103
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029552
KAISER COMMERCIAL NUMBER
CO
Enumeration date
03/22/2021
Last updated
08/16/2024
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