Provider Demographics
NPI:1124358056
Name:CATALANO VAZQUEZ, LEONARDO NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:NICHOLAS
Last Name:CATALANO VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SEMINOLE DR APT 1106
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-0000
Mailing Address - Country:US
Mailing Address - Phone:787-503-1960
Mailing Address - Fax:
Practice Address - Street 1:1010 SEMINOLE DR
Practice Address - Street 2:APT 1106
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3201
Practice Address - Country:US
Practice Address - Phone:787-503-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27315207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009491900Medicaid
FLHN718ZMedicare UPIN