Provider Demographics
NPI:1568418325
Name:VAZQUEZ, LUZ G (MD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:G
Last Name:VAZQUEZ
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 7938
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985-7938
Mailing Address - Country:US
Mailing Address - Phone:772-210-1162
Mailing Address - Fax:772-577-7844
Practice Address - Street 1:1701 SE HILLMOOR DR
Practice Address - Street 2:STE D16
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7541
Practice Address - Country:US
Practice Address - Phone:772-210-1162
Practice Address - Fax:772-577-7844
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME681402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257198600Medicaid
FL31913XOtherMEDICARE
FL257198600Medicaid