| Entity Name: | FRANCISCO M. VAZQUEZ, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Dec 1996 (28 years ago) |
| Document Number: | P96000104040 |
| FEI/EIN Number | 650731497 |
| Address: | 4595 PALM BEACH BLVD., 1, FORT MYERS, FL, 33905, US |
| Mail Address: | 4595 PALM BEACH BLVD., 1, FORT MYERS, FL, 33905, US |
| ZIP code: | 33905 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578873634 | 2010-10-07 | 2010-10-07 | 4595 PALM BEACH BLVD, SUITE 1, FORT MYERS, FL, 339053400, US | 4595 PALM BEACH BLVD, SUITE 1, FORT MYERS, FL, 339053400, US | |||||||||||||||||||||||||
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| Phone | +1 239-694-0533 |
| Fax | 2396941507 |
Authorized person
| Name | FRANCISCO MAXIMO VAZQUEZ |
| Role | DIRECTOR |
| Phone | 2396940533 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME68742 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 265899200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ FRANCISCO M | Agent | 5304 Darby Court, Cape Coral, FL, 33904 |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ FRANCISCO M | President | 5304 Darby Court, Cape Coral, FL, 33904 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2001-03-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
