Healthcare Provider Details

I. General information

NPI: 1821920281
Provider Name (Legal Business Name): YOUNIVERSE DIRECT PRIMARY CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 W 1ST AVE
HIALEAH FL
33012-4414
US

IV. Provider business mailing address

4240 W 1ST AVE
HIALEAH FL
33012-4414
US

V. Phone/Fax

Practice location:
  • Phone: 786-537-2647
  • Fax:
Mailing address:
  • Phone: 786-537-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JANESSY VASQUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 786-537-2647