Provider Demographics
NPI:1922545581
Name:TRASTOY VAZQUEZ, LESTER (SA-C)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:
Last Name:TRASTOY VAZQUEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13941 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6422
Mailing Address - Country:US
Mailing Address - Phone:305-773-5717
Mailing Address - Fax:
Practice Address - Street 1:8400 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4153
Practice Address - Country:US
Practice Address - Phone:305-501-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12-197246ZC0007X
NM76178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant