Healthcare Provider Details

I. General information

NPI: 1164344925
Provider Name (Legal Business Name): GABRIELLA VAZQUEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SW 145TH ST
MIAMI FL
33176-7094
US

IV. Provider business mailing address

9961 SW 145TH ST
MIAMI FL
33176-7094
US

V. Phone/Fax

Practice location:
  • Phone: 305-972-9870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9666102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: