Provider Demographics
NPI:1174758726
Name:VAZQUEZ, KATHYA (MD)
Entity type:Individual
Prefix:
First Name:KATHYA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHYA
Other - Middle Name:
Other - Last Name:RIVERA RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:
Practice Address - Street 1:81 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-7209
Practice Address - Country:US
Practice Address - Phone:828-650-6681
Practice Address - Fax:828-687-9271
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201500862207RE0101X
FLTRN13773207R00000X
FLME 119462207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC0583AMedicare PIN