Provider Demographics
NPI:1821979113
Name:PEREZ VASQUEZ, MARIA ALEJANDRA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:PEREZ VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 PARK SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6258
Mailing Address - Country:US
Mailing Address - Phone:407-485-9807
Mailing Address - Fax:
Practice Address - Street 1:1628 PARK SIDE AVE
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:FL
Practice Address - Zip Code:34744-6258
Practice Address - Country:US
Practice Address - Phone:407-485-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11041808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine