Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME0070014 | FL |
NPI | 1174511729 |
---|---|
Provider Name | Dr. Juan C Fleites Vazquez |
First Address | Miami, FL 33145-3249 |
Second Address | Miami, FL 33145-3249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 21/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
379975100 | (05) | FL |
G42418 | (02) | FL |