Provider Demographics
NPI:1104515824
Name:VEGA CURBELO, LIDICE
Entity type:Individual
Prefix:
First Name:LIDICE
Middle Name:
Last Name:VEGA CURBELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18212 SW 109TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-9006
Mailing Address - Country:US
Mailing Address - Phone:786-237-8869
Mailing Address - Fax:
Practice Address - Street 1:18212 SW 109TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-9006
Practice Address - Country:US
Practice Address - Phone:786-237-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF04230111363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care