Provider Demographics
NPI:1235335076
Name:KUWAJIMA, VANESSA KEITH VIEIRA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:KEITH VIEIRA
Last Name:KUWAJIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2485
Mailing Address - Country:US
Mailing Address - Phone:321-690-0002
Mailing Address - Fax:321-632-1358
Practice Address - Street 1:1273 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2485
Practice Address - Country:US
Practice Address - Phone:321-690-0002
Practice Address - Fax:321-632-1358
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150393207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015236Medicare PIN