Basic Information
| Provider Information | |||||||||
| NPI: | 1477282366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAZQUEZ- GARCIA | ||||||||
| FirstName: | SANDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | BA, CADC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2887 S MARYLAND PKWY # 89109 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891091511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024744104 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2887 S MARYLAND PKWY # 89109 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891091511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024744104 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2022 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 07096-I | NV | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.