Provider Demographics
NPI:1376616813
Name:VAZQUEZ, BERNABE (MD)
Entity Type:Individual
Prefix:
First Name:BERNABE
Middle Name:
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 1:3661 S MIAMI AVENUE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133
Mailing Address - Country:US
Mailing Address - Phone:305-858-8222
Mailing Address - Fax:305-854-2112
Practice Address - Street 1:3661 S MIAMI AVENUE
Practice Address - Street 2:SUITE 508
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-858-8222
Practice Address - Fax:305-854-2112
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39681208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D51389Medicare UPIN
05674Medicare ID - Type Unspecified