MEDICARE: MAGDA VAZQUEZ M.D.

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	207VG0400X	Gynecology Physician	ACN88	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1750476982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDA VAZQUEZ M.D.

Provider Business Mailing Address
First Line	:	780 SW 24TH ST
Second Line	:	MEDICAL ADMINISTRATION
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2643
Country	:	US
Telephone Number	:	954-467-4822
Fax Number	:	954-760-7798

Provider Business Practice Location Address
First Line	:	2421 SW 6TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2613
Country	:	US
Telephone Number	:	954-467-4822
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/09/2007

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