Healthcare Provider Details

I. General information

NPI: 1750507794
Provider Name (Legal Business Name): ANGELICA BETINA VAZQUEZ ANAYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 256-288-3333
  • Fax: 256-429-9411
Mailing address:
  • Phone: 256-975-4291
  • Fax: 256-325-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2012-01125
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number67623
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.52357
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: