Provider Demographics
NPI:1598416265
Name:VAZQUEZ OCASIO, SHABRIEL JAVIER (MBBS, MD, CRC)
Entity Type:Individual
Prefix:DR
First Name:SHABRIEL
Middle Name:JAVIER
Last Name:VAZQUEZ OCASIO
Suffix:
Gender:M
Credentials:MBBS, MD, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:
Practice Address - Street 1:194 MARION OAKS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-2215
Practice Address - Country:US
Practice Address - Phone:352-290-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23611208D00000X
FLACN1598208D00000X
PR16466-I390200000X
PR16466I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program