Individual
MRS. KRISTINE KAY VASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
122 S 3RD ST, WILLIAMS, AZ 86046-2404
(928) 635-1477
(928) 635-0143
Mailing address
222 S GOLDEN MEADOW TRL, WILLIAMS, AZ 86046-9625
(928) 635-2042
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0411
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19033560
WORKER'S COMP
AZ
01
—
771479
AHCCCS
AZ
01
—
AZ0293560
BCBS
AZ
Enumeration date
04/24/2006
Last updated
07/08/2007
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