MEDICARE: DR. MARTIN GIOVANNI VAZQUEZ MIRANDA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ACN1670	FL
2	208D00000X	General Practice Physician	23729	PR

General Provider Information

NPI Number	:	1609618743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN GIOVANNI VAZQUEZ MIRANDA MD

Provider Business Mailing Address
First Line	:	4949 6TH ST
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-5736
Country	:	US
Telephone Number	:	787-674-4286
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 6TH ST
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-5736
Country	:	US
Telephone Number	:	321-422-2303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	04/04/2025

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