Healthcare Provider Details

I. General information

NPI: 1205097953
Provider Name (Legal Business Name): LILLIANA VAZQUEZ RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3402
US

IV. Provider business mailing address

1 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3402
US

V. Phone/Fax

Practice location:
  • Phone: 305-432-9565
  • Fax: 305-573-9669
Mailing address:
  • Phone: 305-432-9565
  • Fax: 305-573-9669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME115776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: