MEDICARE: DR. HUMBERTO R VAZQUEZ M.D.

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	208000000X	Pediatrics Physician	3905	PR

General Provider Information

NPI Number	:	1164407490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUMBERTO R VAZQUEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 364266
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-4266
Country	:	US
Telephone Number	:	787-727-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 AUGUSTO RODRIGUEZ ST
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2214
Country	:	US
Telephone Number	:	787-727-2140
Fax Number	:

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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