Provider Demographics
NPI:1013450477
Name:VAZQUEZ, VALERIE KATIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:KATIANA
Last Name:VAZQUEZ
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 1:13164 SW 8TH LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0108
Mailing Address - Country:US
Mailing Address - Phone:787-405-2019
Mailing Address - Fax:
Practice Address - Street 1:2970 W US HIGHWAY 90 STE 110
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4703
Practice Address - Country:US
Practice Address - Phone:386-247-6910
Practice Address - Fax:386-247-6915
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL162902208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery