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NPI Code Detail

MEDICARE: JORGE L ACEVEDO VAZQUEZ

MEDICARE:   JORGE L ACEVEDO VAZQUEZ
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
1208D00000XGeneral Practice PhysicianACN651FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609853225
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE L ACEVEDO VAZQUEZ
Provider Business Mailing Address
First Line : 7630 SOUTHERN BROOK BND
Second Line : APT 205
City : TAMPA
State : FL
Zip : 33635-1824
Country : US
Telephone Number : 787-667-0988
Fax Number : 787-667-0988
Provider Business Practice Location Address
First Line : 4160 N ARMENIA AVE STE A
Second Line :
City : TAMPA
State : FL
Zip : 33607-6453
Country : US
Telephone Number : 855-226-6633
Fax Number : 866-285-7068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2005
Last Update Date : 09/27/2023

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Directions to “ JORGE L ACEVEDO VAZQUEZ ” Practice Location

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