Provider Demographics
NPI:1174511729
Name:FLEITES VAZQUEZ, JUAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:FLEITES 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 1:3181 CORAL WAY STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3249
Mailing Address - Country:US
Mailing Address - Phone:305-856-1002
Mailing Address - Fax:866-809-8253
Practice Address - Street 1:3181 CORAL WAY STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3249
Practice Address - Country:US
Practice Address - Phone:305-856-1002
Practice Address - Fax:866-809-8253
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00700142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379975100Medicaid
FL379975100Medicaid
FL28862AMedicare ID - Type Unspecified