Most Relevant Information
Provider Data
| NPI Number: | 1003317967 |
| Provider Name: | JOSE GUSTAVO VAZQUEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/26/2018 |
| Last Updated: | 02/26/2018 |
Provider Practice Location
5020 ALTA DR STE B
LAS VEGAS
NV
891073940
Practice Location Phone/Fax
| Phone: | 7026853418 |
| Fax: |
Provider Mailing Location
5020 ALTA DR STE B
LAS VEGAS
NV
891073940
Provider Mailing Phone/Fax
| Phone: | 7026853418 |
| Fax: |