Provider Demographics
NPI:1669116661
Name:VAZQUEZ MALDONADO, GABRIEL A (CRNA)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:A
Last Name:VAZQUEZ MALDONADO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7050 GALL BLVD FL 33541
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1347
Mailing Address - Country:US
Mailing Address - Phone:181-378-8041
Mailing Address - Fax:
Practice Address - Street 1:7050 GALL BLVD FL 33541
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1347
Practice Address - Country:US
Practice Address - Phone:181-378-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019380367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered