Provider Demographics
NPI:1659320380
Name:VAZQUEZ, LISETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:LISETTE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1019
Mailing Address - Country:US
Mailing Address - Phone:305-606-4677
Mailing Address - Fax:
Practice Address - Street 1:909 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4408
Practice Address - Country:US
Practice Address - Phone:305-606-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL170465OtherHUMANA
FL304927OtherAVMED
FL48582OtherBCBS
FL57338OtherNHP
FL7617825OtherAETNA
FL48582OtherBCBS
FL7617825OtherAETNA