MEDICARE: DR. YULIA NIETO VAZQUEZ

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	183500000X	Pharmacist	PS62987	FL

General Provider Information

NPI Number	:	1649992785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YULIA NIETO VAZQUEZ

Provider Business Mailing Address
First Line	:	16544 SW 85TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5794
Country	:	US
Telephone Number	:	786-728-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 NE 10TH CT
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33033-4712
Country	:	US
Telephone Number	:	305-242-0377
Fax Number	:

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

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/15/2022

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