Provider Demographics
NPI:1346684677
Name:VAZQUEZ ORTIZ, MARIOLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIOLA
Middle Name:
Last Name:VAZQUEZ ORTIZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARIOLA
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10001 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3092
Mailing Address - Country:US
Mailing Address - Phone:305-271-4734
Mailing Address - Fax:
Practice Address - Street 1:8350 NW 52ND TER
Practice Address - Street 2:SUITE 301
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-7811
Practice Address - Country:US
Practice Address - Phone:305-463-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 287631835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy