Provider Demographics
NPI:1326219767
Name:VAZQUEZ-ROJAS, ODETTE MIREYA (MD)
Entity Type:Individual
Prefix:
First Name:ODETTE
Middle Name:MIREYA
Last Name:VAZQUEZ-ROJAS
Suffix:
Gender:F
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:904-697-4203
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:521 W STATE ROAD 434 STE 101
Practice Address - Street 2:PEDIATRIC&ADOLESCENT MED OF SEMINOLE, IN ASSOC WITH NEM
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4952
Practice Address - Country:US
Practice Address - Phone:407-830-5437
Practice Address - Fax:407-830-4907
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103485208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001325400Medicaid