Healthcare Provider Details

I. General information

NPI: 1295926822
Provider Name (Legal Business Name): MARZANNA VASINGTON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OVERSEAS HWY
MARATHON FL
33050-2329
US

IV. Provider business mailing address

3600 RED RD STE 401
MIRAMAR FL
33025-6014
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-3584
  • Fax:
Mailing address:
  • Phone: 754-400-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60250498
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS18482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: