MEDICARE: DR. LILLIANA MORALES-VASQUEZ 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	207R00000X	Internal Medicine Physician	17493	PR
2	207RG0100X	Gastroenterology Physician	17493	PR

General Provider Information

NPI Number	:	1215130588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILLIANA MORALES-VASQUEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 16598
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00908-6598
Country	:	US
Telephone Number	:	787-525-6075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 CALLE AMERICO SALAS STE 103
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2104
Country	:	US
Telephone Number	:	787-722-1717
Fax Number	:	787-723-1595

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/03/2012

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