Provider Demographics
NPI:1841383262
Name:VAZQUEZ GARCIA, MILDRED (MD)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:VAZQUEZ GARCIA
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 1:509 CAGAN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6405
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:810 N NOWELL ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7539
Practice Address - Country:US
Practice Address - Phone:407-290-9556
Practice Address - Fax:407-630-6884
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075420207R00000X
FLACN1328208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110026300Medicaid
MIH16055Medicare UPIN