Individual
MR. RICARDO FELIX VAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA, NREMT
Contact information
Practice address
2300 SPRUCE PL, WHITE BEAR LAKE, MN 55110-4871
(651) 788-2881
Mailing address
2300 SPRUCE PL, WHITE BEAR LAKE, MN 55110-4871
(651) 788-2881
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
E3018291
MN
225200000X
Physical Therapy Assistant
2115596
TX
225200000X
Physical Therapy Assistant
Primary
A1957
MN
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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