Healthcare Provider Details

I. General information

NPI: 1194110023
Provider Name (Legal Business Name): SANDRA VAZQUEZ DIAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 11/03/2023
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CENTRAL AVE STE 100A
TOLEDO OH
43606-3817
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-8400
  • Fax: 419-291-8405
Mailing address:
  • Phone: 419-291-8400
  • Fax: 419-291-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMT216252
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35.142948
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: