Provider Demographics
NPI:1255315180
Name:VAZQUEZ, CARLOS A (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name: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 1:8000 SW 117 AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4809
Mailing Address - Country:US
Mailing Address - Phone:305-279-0152
Mailing Address - Fax:305-279-2602
Practice Address - Street 1:8000 SW 117 AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4809
Practice Address - Country:US
Practice Address - Phone:305-279-0152
Practice Address - Fax:305-279-2602
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88238OtherME
FL272168600Medicaid
FL81255OtherMEDICARE
FLI21305Medicare UPIN