Provider Demographics
NPI:1447463344
Name:VAZQUEZ, BIANCA J (MD)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:J
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10250 N 92ND ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4518
Mailing Address - Country:US
Mailing Address - Phone:480-454-8182
Mailing Address - Fax:480-499-5558
Practice Address - Street 1:10250 N 92ND ST STE 202
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4518
Practice Address - Country:US
Practice Address - Phone:480-454-8182
Practice Address - Fax:480-499-5558
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN53502208600000X
MN104901208600000X
AZ53356208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ637967Medicaid
MNENROLLEDMedicaid