Organization
LISETTE VAZQUEZ DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISETTE VAZQUEZ DO, PA (PRESIDENT)
(786) 243-4100
Entity
Organization
Contact information
Practice address
909 N KROME AVE, HOMESTEAD, FL 33030-4408
(786) 243-4100
(786) 243-4111
Mailing address
5663 SW 2ND ST, MIAMI, FL 33134-1019
(786) 243-4100
(786) 243-4111
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
OS9315
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170465
HUMANA
FL
01
—
304927
AVMED
FL
01
—
48582
BCBS
FL
01
—
57338
NHP
FL
01
—
7617825
AETNA
FL
Enumeration date
02/05/2007
Last updated
01/30/2008
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