Provider Demographics
NPI:1063861243
Name:VAZQUEZ, AITZA (BS)
Entity Type:Individual
Prefix:
First Name:AITZA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 W FLAGLER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2470
Mailing Address - Country:US
Mailing Address - Phone:305-377-3297
Mailing Address - Fax:
Practice Address - Street 1:7575 W FLAGLER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2470
Practice Address - Country:US
Practice Address - Phone:305-377-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator