Healthcare Provider Details

I. General information

NPI: 1982986394
Provider Name (Legal Business Name): ERNIE VAZQUEZ-WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ERNIE VAZQUEZ WHITE M.D.

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR SAN DIEGO CA 92134
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 787-223-0082
  • Fax:
Mailing address:
  • Phone: 787-223-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19472
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: