Provider Demographics
NPI:1376207803
Name:ROSADO-VAZQUEZ, WILLY JOE (SA-C)
Entity Type:Individual
Prefix:
First Name:WILLY
Middle Name:JOE
Last Name:ROSADO-VAZQUEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 SW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2446
Mailing Address - Country:US
Mailing Address - Phone:305-794-0215
Mailing Address - Fax:
Practice Address - Street 1:2633 SW 188TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2446
Practice Address - Country:US
Practice Address - Phone:305-794-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant