Provider Demographics
NPI:1588834642
Name:VAZQUEZ-PAUSA, BENIBEL MONTAS
Entity Type:Individual
Prefix:
First Name:BENIBEL
Middle Name:MONTAS
Last Name:VAZQUEZ-PAUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15150 BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2167
Mailing Address - Country:US
Mailing Address - Phone:305-364-0969
Mailing Address - Fax:305-364-0937
Practice Address - Street 1:15150 BULL RUN RD
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2167
Practice Address - Country:US
Practice Address - Phone:305-364-0969
Practice Address - Fax:305-364-0937
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist