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General NPI Number Information
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NPI Number | 1619016185
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Entity Type | Organization
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Legal Business Name | LISETTE VAZQUEZ DO PA
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 909 N KROME AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-4408
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Country | US
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Telephone | 786-243-4100
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Fax | 786-243-4111
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Provider Business Mailing Address
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Address Line | 5663 SW 2ND ST
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City | MIAMI
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State | FL
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Zip | 33134-1019
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Country | US
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Telephone | 786-243-4100
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Fax | 786-243-4111
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISETTE VAZQUEZ
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Credential | DO, PA
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Telephone | 786-243-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OS9315
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License Number State | FL
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