Basic Information
| Provider Information | |||||||||
| NPI: | 1316573850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMHOTEPCX INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7101 SW 21ST ST | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331551622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865388989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7031 SW 62ND AVE | ||||||||
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| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052847500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2020 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUEVARA VAZQUEZ | ||||||||
| AuthorizedOfficialFirstName: | VLADIMIR | ||||||||
| AuthorizedOfficialMiddleName: | ALEJANDRO | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/ PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 7865388989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.