Provider Demographics
NPI:1609360841
Name:VASQUEZ, JANESSY (MD)
Entity Type:Individual
Prefix:DR
First Name:JANESSY
Middle Name:
Last Name:VASQUEZ
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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:786-515-9308
Practice Address - Street 1:2020 NE 48TH CT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4522
Practice Address - Country:US
Practice Address - Phone:954-751-4671
Practice Address - Fax:954-568-1330
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125072513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine