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General NPI Number Information
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NPI Number | 1336519693
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Entity Type | Organization
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Legal Business Name | M & M PEDIATRICS P.A.
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 18503 PINES BLVD STE 212
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1405
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Country | US
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Telephone | 954-392-0266
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Fax | 954-392-0267
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Provider Business Mailing Address
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Address Line | 18503 PINES BLVD STE 212
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1405
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Country | US
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Telephone | 954-392-0266
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Fax | 954-392-0267
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. MARTHA MAYORGA VASQUEZ
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Credential | M.D.
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Telephone | 954-392-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME66599
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License Number State | FL
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