MEDICARE: CARMEN VASQUEZ PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1285567495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN VASQUEZ PEREZ

Provider Business Mailing Address
First Line	:	231 N. KENTUCKY AVE.
Second Line	:	STE. 215
City	:	LAKELAND
State	:	FL
Zip	:	33801
Country	:	US
Telephone Number	:	407-697-3266
Fax Number	:	863-583-0806

Provider Business Practice Location Address
First Line	:	231 N KENTUCKY AVE STE 215
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4910
Country	:	US
Telephone Number	:	407-697-3266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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Directions to “ CARMEN VASQUEZ PEREZ ” Practice Location

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