Provider Demographics
NPI:1811573827
Name:VANEGAS, MARIE-LAURIE (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE-LAURIE
Middle Name:
Last Name:VANEGAS
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 N KENDALL DR STE 215
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7758
Mailing Address - Country:US
Mailing Address - Phone:786-433-2450
Mailing Address - Fax:786-607-3047
Practice Address - Street 1:7887 N KENDALL DR STE 215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7758
Practice Address - Country:US
Practice Address - Phone:786-433-2450
Practice Address - Fax:786-607-3047
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114141363AS0400X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical