MEDICARE: YOUNIVERSE DIRECT PRIMARY CARE, LLC.

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

General Provider Information

NPI Number	:	1821920281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNIVERSE DIRECT PRIMARY CARE, LLC.

Provider Business Mailing Address
First Line	:	4240 W 1ST AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4414
Country	:	US
Telephone Number	:	786-537-2647
Fax Number	:

Provider Business Practice Location Address
First Line	:	4240 W 1ST AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4414
Country	:	US
Telephone Number	:	786-537-2647
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANESSY VASQUEZ
Credential	:	MD
Telephone Number	:	786-537-2647

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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