Individual
MAYRA VAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
774 SQUIRREL CT, KISSIMMEE, FL 34759-4311
(417) 312-3135
Mailing address
774 SQUIRREL CT, KISSIMMEE, FL 34759-4311
(417) 312-3135
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015123600
—
FL
Enumeration date
03/05/2017
Last updated
03/05/2017
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