=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528703683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR VAZQUEZ THERAPY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2022
-----------------------------------------------------
Last Update Date | 05/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 BLUE LAGOON DR STE 810
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-335-8288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6521 SW 25TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-2946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-335-8288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA VAZQUEZ
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 305-335-8288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------