Individual provider Active NPI

Dibanni Vasquez, M.D.

  • Pediatrics Physician
  • Lake Park, FL
National Provider Identifier
1124319611
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME 109534 Issued in FL
Practice address
500 US Highway 1
Lake Park, FL 33403-3598
Phone
(407) 898-2767
Fax
(407) 898-9443
NPI assigned
May 2, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X ME109534 FL
Pediatrics Physician 208000000X ME 109534 FL Primary

Addresses

Primary practice location

500 US Highway 1
Lake Park, FL 33403-3598

Mailing address

2660 W Fairbanks Ave
Winter Park, FL 32789-3385
Phone (407) 898-2767

Other practice location 1

561 NW Lake Whitney Pl Ste 101
Port St Lucie, FL 34986-1624
Phone (407) 898-2767

Other identifiers 1

IdentifierTypeStateIssuer
119093800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130402000371 FL Practitioner - Pediatric Medicine 0244475812 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 109534FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Emergency Services LLC Pediatrics CurrentSince Dec 1, 2019 Accepting new patients
Hospital Physician Services of Florida PA CurrentSince Dec 1, 2019 Accepting new patients
South Miami Criticare Inc. CurrentSince Apr 1, 2016 Accepting new patients
Emergency Physician Solutions of South Florida, LLC PastSince Mar 1, 2020 Accepting new patients
Orlando Pediatric Pulmonary and Sleep Associates PA Pediatric Pulmonology Past Accepting new patients

Locations

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

8383 N Davis Hwy
Pensacola, FL 32514
Phone (850) 494-3212

9400 W Highway 98
Pensacola, FL 32506
Phone (850) 457-2200

6200 SW 73rd St
South Miami, FL 33143
Phone (305) 661-4611

Interoperability endpoints

  • Direct secure messaging: dvasquez493151@direct.memorialcare.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1124319611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2660 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893385",
            "telephone_number": "407-898-2767",
            "fax_number": "407-898-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 US HIGHWAY 1",
            "city": "LAKE PARK",
            "state": "FL",
            "postal_code": "334033598",
            "telephone_number": "407-898-2767",
            "fax_number": "407-898-9443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "561 NW Lake Whitney Pl Ste 101",
            "address_purpose": "LOCATION",
            "city": "Port St Lucie",
            "state": "FL",
            "postal_code": "349861624",
            "country_code": "US",
            "telephone_number": "407-898-2767",
            "fax_number": "407-898-9443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "DIBANNI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-02",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "FL",
            "license": "ME109534",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME 109534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119093800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Park, FL

Sources for this page

Verify at the official NPI Registry.