Healthcare Provider Details

I. General information

NPI: 1467499822
Provider Name (Legal Business Name): CARIDAD LOZADA VACLAVEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CARRIE LADAOZ VACLAVEK M.D.

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 N KENDALL DR SUITE 211
MIAMI FL
33176-2299
US

IV. Provider business mailing address

8720 N KENDALL DR SUITE 211
MIAMI FL
33176-2299
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-5253
  • Fax: 305-279-5810
Mailing address:
  • Phone: 305-279-5253
  • Fax: 305-279-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: