Provider Demographics
NPI:1861216194
Name:MEDRANO VAZQUEZ, PAULETTA
Entity type:Individual
Prefix:
First Name:PAULETTA
Middle Name:
Last Name:MEDRANO VAZQUEZ
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 1:19330 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4133
Mailing Address - Country:US
Mailing Address - Phone:305-987-9312
Mailing Address - Fax:
Practice Address - Street 1:9100 S DADELAND BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7814
Practice Address - Country:US
Practice Address - Phone:305-351-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30212716364SL0600X, 374U00000X, 3747A0650X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker