Provider Demographics
NPI:1619243391
Name:MERCEDES J VAZQUEZ MD PA
Entity Type:Organization
Organization Name:MERCEDES J VAZQUEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-242-0911
Mailing Address - Street 1:950 N KROME AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4400
Mailing Address - Country:US
Mailing Address - Phone:305-242-0911
Mailing Address - Fax:305-242-0912
Practice Address - Street 1:950 N KROME AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4400
Practice Address - Country:US
Practice Address - Phone:305-242-0911
Practice Address - Fax:305-242-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty