Healthcare Provider Details

I. General information

NPI: 1225361736
Provider Name (Legal Business Name): MILAGROS M FERNANDEZ VAZQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 DON WICKHAM DR STE 115
CLERMONT FL
34711-1977
US

IV. Provider business mailing address

1920 DON WICKHAM DR STE 115
CLERMONT FL
34711-1977
US

V. Phone/Fax

Practice location:
  • Phone: 352-536-8761
  • Fax: 321-842-8290
Mailing address:
  • Phone: 352-536-8761
  • Fax: 321-842-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME134658
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12405
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: