Provider Demographics
NPI:1689248627
Name:VAZQUEZ JUSTINIANO, LUIS FLORENTINO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FLORENTINO
Last Name:VAZQUEZ JUSTINIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W. EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570
Mailing Address - Country:US
Mailing Address - Phone:956-296-1816
Mailing Address - Fax:956-296-1816
Practice Address - Street 1:2810 W. EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570
Practice Address - Country:US
Practice Address - Phone:956-296-1816
Practice Address - Fax:956-296-1816
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program