Organization
NEUROLOGY RESTORATION CENTER LLC
Active
Other names
Neurology Restoration
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUZ G VAZQUEZ MD (OWNER/MD)
(772) 210-1162
Entity
Organization
Contact information
Practice address
1701 SE HILLMOOR DR, SUITE D-16, PORT SAINT LUCIE, FL 34952-7552
(772) 201-1162
Mailing address
PO BOX 7938, PORT SAINT LUCIE, FL 34985-7938
(772) 210-1162
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME68140
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257198600
—
FL
Enumeration date
08/23/2016
Last updated
10/02/2017
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