=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841383262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILDRED VAZQUEZ GARCIA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2006
-----------------------------------------------------
Last Update Date | 12/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 N NOWELL ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32808-7539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-290-9556
-----------------------------------------------------
Fax | 407-630-6884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 CAGAN VIEW RD
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34714-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-905-8827
-----------------------------------------------------
Fax | 407-286-4515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301075420
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ACN1328
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------