Healthcare Provider Details

I. General information

NPI: 1841321833
Provider Name (Legal Business Name): ANDRES VASQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 NW 36TH ST
MIAMI FL
33142-5557
US

IV. Provider business mailing address

8920 CRESCENT DR
MIRAMAR FL
33025-2422
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7444
  • Fax:
Mailing address:
  • Phone: 305-951-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0056851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: