Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME55573 | FL |
N | 207VX0000X | Obstetrician | ME55573 | FL |
NPI | 1306954060 |
---|---|
Provider Name | Mr. Javier Vizoso |
First Address | South Miami, FL 33143-4800 |
Second Address | South Miami, FL 33143-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 16/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26633 | (02) | FL |