Healthcare Provider Details

I. General information

NPI: 1669671590
Provider Name (Legal Business Name): MARLON ALVARO VAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9685 LAKE NONA VILLAGE PL STE 103
ORLANDO FL
32827-7321
US

IV. Provider business mailing address

1400 E OAKLAND PARK BLVD STE 210
OAKLAND PARK FL
33334-4400
US

V. Phone/Fax

Practice location:
  • Phone: 407-557-8160
  • Fax: 407-557-8159
Mailing address:
  • Phone: 954-561-6222
  • Fax: 954-990-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME115139
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME115139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: