Provider Demographics
NPI:1518711076
Name:VAZQUEZ, LEODAN SR (SPL)
Entity Type:Individual
Prefix:MR
First Name:LEODAN
Middle Name:
Last Name:VAZQUEZ
Suffix:SR
Gender:M
Credentials:SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 8TH ST APT 17
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4366
Mailing Address - Country:US
Mailing Address - Phone:786-637-3846
Mailing Address - Fax:
Practice Address - Street 1:13820 LAKE CLAIRE CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-3030
Practice Address - Country:US
Practice Address - Phone:305-901-5576
Practice Address - Fax:305-363-4555
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist