Active NPI
Eduardo Manuel Vazquez, PA
- Physician Assistant
- Sun City Center, FL
National Provider Identifier
1164468849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9102376
- Practice address
- 4031 Upper Creek Dr
Sun City Center, FL 33573-6819 - Phone
- (813) 633-2733
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9102376 | FL | Primary |
Addresses
Primary practice location
4031 Upper Creek Dr
Sun City Center, FL 33573-6819
Mailing address
4031 Upper Creek Dr
Sun City Center, FL 33573-6819
Phone (813) 633-2733
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 292832900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9102376 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320105600000",
"number": "1164468849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4031 UPPER CREEK DR",
"city": "SUN CITY CENTER",
"state": "FL",
"postal_code": "335736819",
"telephone_number": "813-633-2733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4031 UPPER CREEK DR",
"city": "SUN CITY CENTER",
"state": "FL",
"postal_code": "335736819",
"telephone_number": "813-633-2733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAZQUEZ",
"first_name": "EDUARDO",
"middle_name": "MANUEL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-21",
"last_updated": "2011-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9102376",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "292832900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sun City Center, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.