Healthcare Provider Details

I. General information

NPI: 1235335076
Provider Name (Legal Business Name): VANESSA KEITH VIEIRA KUWAJIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 US HIGHWAY 1
ROCKLEDGE FL
32955-2849
US

IV. Provider business mailing address

1268 US HIGHWAY 1
ROCKLEDGE FL
32955-2849
US

V. Phone/Fax

Practice location:
  • Phone: 321-433-3000
  • Fax: 321-433-3001
Mailing address:
  • Phone: 321-433-3000
  • Fax: 321-433-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME150393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: