MEDICARE: MS. LESLIE A. VAZQUEZ GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	1876	PR

General Provider Information

NPI Number	:	1114349222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE A. VAZQUEZ GARCIA

Provider Business Mailing Address
First Line	:	926 CALLE ZUMBADOR
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3346
Country	:	US
Telephone Number	:	787-316-2144
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 CALLE ZUMBADOR
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3346
Country	:	US
Telephone Number	:	787-316-2144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	07/17/2014

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