Provider Demographics
NPI:1154393221
Name:VAZQUEZ-PERTEJO, MARIA T (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:VAZQUEZ-PERTEJO
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 1:3461 FAIRLANE FARMS RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8752
Mailing Address - Country:US
Mailing Address - Phone:561-766-1300
Mailing Address - Fax:561-693-0539
Practice Address - Street 1:3461 FAIRLANE FARMS RD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8752
Practice Address - Country:US
Practice Address - Phone:561-766-1300
Practice Address - Fax:561-693-0539
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079884207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35281OtherBLUE CROSS BLUE SHIELD
FL258840400Medicaid
H18580Medicare UPIN
FL35281ZMedicare ID - Type Unspecified