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General NPI Number Information
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NPI Number | 1316573850
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Entity Type | Organization
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Legal Business Name | IMHOTEPCX INC
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1201 N 37TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5414
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Country | US
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Telephone | 754-777-5600
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Fax | 510-281-1437
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Provider Business Mailing Address
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Address Line | 7101 SW 21ST ST
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City | MIAMI
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State | FL
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Zip | 33155-1622
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Country | US
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Telephone | 786-538-8989
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/ PSYCHIATRIST
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Name | DR. VLADIMIR ALEJANDRO GUEVARA VAZQUEZ
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Credential | MD
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Telephone | 786-538-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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