Healthcare Provider Details

I. General information

NPI: 1831877422
Provider Name (Legal Business Name): VAZQUEZ ESTEBAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 82ND AVE STE 405
PLANTATION FL
33324-1835
US

IV. Provider business mailing address

304 INDIAN TRCE BOX 242
WESTON FL
33326-2996
US

V. Phone/Fax

Practice location:
  • Phone: 954-256-4416
  • Fax: 888-613-5717
Mailing address:
  • Phone: 787-432-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HECTOR VAZQUEZ
Title or Position: MANAGER
Credential: MD
Phone: 954-256-4416