Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | ME61705 | FL |
Y | 2080P0214X | Pediatric Pulmonologist | ME61705 | FL |
NPI | 1477535615 |
---|---|
Provider Name | Dr. Samuel Vazquez-Agosto |
First Address | Pembroke Pines, FL 33027-1761 |
Second Address | Pembroke Pines, FL 33027-1761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 16/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370953100 | (05) | FL |
F36604 | (02) | FL |