Provider Demographics
NPI:1043510985
Name:VAZQUEZ, MIGDRES (COTA)
Entity Type:Individual
Prefix:
First Name:MIGDRES
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 BLAIREMONT WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7427
Mailing Address - Country:US
Mailing Address - Phone:407-406-9466
Mailing Address - Fax:
Practice Address - Street 1:12112 BLAIREMONT WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7427
Practice Address - Country:US
Practice Address - Phone:407-406-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 11124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health