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General NPI Number Information
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NPI Number | 1659320380
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Entity Type | Individual
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Provider Name | LISETTE VAZQUEZ D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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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 | 305-606-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 5663 SW 2ND ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1019
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Country | US
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Telephone | 305-606-4677
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS9315
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License Number State | FL
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