Individual
NICOLAS E CENTENO VAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1330 LAKE FRANCIS DR, APOPKA, FL 32712-2120
(787) 370-9628
Mailing address
1330 LAKE FRANCIS DR, APOPKA, FL 32712-2120
(787) 370-9628
(352) 241-6361
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
879
PR
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
879
PUERTO RICO MEDICAL LICENSE
PR
Enumeration date
08/27/2008
Last updated
08/15/2018
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