Provider Demographics
NPI:1194944611
Name:NIVIA E. VAZQUEZ, M.D.,P.A.
Entity type:Organization
Organization Name:NIVIA E. VAZQUEZ, M.D.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIVIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-246-1030
Mailing Address - Street 1:925 NE 30TH TER STE 202
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7614
Mailing Address - Country:US
Mailing Address - Phone:305-246-1030
Mailing Address - Fax:305-246-2387
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:SUITE #202
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7613
Practice Address - Country:US
Practice Address - Phone:305-246-1030
Practice Address - Fax:305-246-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266494100Medicaid