Healthcare Provider Details

I. General information

NPI: 1053694000
Provider Name (Legal Business Name): KATERINA VIGOA ZAMORA PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 PINE TREE DR
MIAMI BEACH FL
33140-3601
US

IV. Provider business mailing address

6941 CARLYLE AVE APT 402
MIAMI BEACH FL
33141-3173
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-9737
  • Fax:
Mailing address:
  • Phone: 305-993-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: