1073478582 NPI number — MARIAN AMANDA VAZQUEZ NUNEZ MS

Table of content: MARIAN AMANDA VAZQUEZ NUNEZ MS (NPI 1073478582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073478582 NPI number — MARIAN AMANDA VAZQUEZ NUNEZ MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ NUNEZ
Provider First Name:
MARIAN
Provider Middle Name:
AMANDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073478582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 NW 177TH ST APT 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33015-6235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-533-6272
Provider Business Mailing Address Fax Number:
786-238-7694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 NW 177TH ST APT 210
Provider Second Line Business Practice Location Address:
APART 210
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33015-6235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-533-6272
Provider Business Practice Location Address Fax Number:
786-238-7694
Provider Enumeration Date:
12/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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