Provider Demographics
NPI:1841620390
Name:VAZQUEZ, GLORIA M
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:M
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8200 W SUNRISE BLVD STE A5
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5426
Mailing Address - Country:US
Mailing Address - Phone:954-314-7423
Mailing Address - Fax:954-314-7426
Practice Address - Street 1:8200 W SUNRISE BLVD STE A5
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5426
Practice Address - Country:US
Practice Address - Phone:954-314-7423
Practice Address - Fax:954-314-7426
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN 796208D00000X
PR15318I282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282N00000XHospitalsGeneral Acute Care Hospital