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General NPI Number Information
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NPI Number | 1376530196
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Entity Type | Individual
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Provider Name | MARTHA L MAYORGA-VASQUEZ MD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 03/26/2021
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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 |
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Name |
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Credential |
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Telephone |
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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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