=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831877422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAZQUEZ ESTEBAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2023
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 NW 82ND AVE STE 405
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-256-4416
-----------------------------------------------------
Fax | 888-613-5717
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 INDIAN TRCE BOX 242
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33326-2996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-432-4662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | HECTOR VAZQUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-256-4416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------