Family Practice Center of Brandon LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0069553 Issued in FL

Legal business name

FAMILY PRACTICE CENTER OF BRANDON LLC

Practice address

814 Vittorio PL
Brandon, FL 33511-6659

Phone

(813) 681-6064

Fax

(813) 653-4132

NPI assigned

Sep 22, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Miguel Mazariegos, M.D.

Title

Physician

Phone

(813) 681-6064

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1487962619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 VITTORIO PL",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116659",
            "telephone_number": "813-681-6064",
            "fax_number": "813-653-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 VITTORIO PL",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116659",
            "telephone_number": "813-681-6064",
            "fax_number": "813-653-4132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE CENTER OF BRANDON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "MAZARIEGOS",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "813-681-6064",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0069553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378959400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Brandon, FL
• Providers in Brandon, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.