Provider Demographics
NPI:1609618743
Name:VAZQUEZ MIRANDA, MARTIN GIOVANNI (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GIOVANNI
Last Name:VAZQUEZ MIRANDA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-5736
Mailing Address - Country:US
Mailing Address - Phone:787-674-4286
Mailing Address - Fax:
Practice Address - Street 1:4949 6TH ST
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-5736
Practice Address - Country:US
Practice Address - Phone:321-422-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1670207Q00000X
PR23729208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty