Individual
JAVIER MARTIN VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STA
Contact information
Practice address
5316 TRAIL LAKE DR, FORT WORTH, TX 76133-1931
(817) 292-8787
(817) 789-6849
Mailing address
5316 TRAIL LAKE DR, FORT WORTH, TX 76133-1931
(817) 292-8787
(817) 789-6849
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
35399
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149984001
—
TX
Enumeration date
03/15/2010
Last updated
03/15/2010
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