Healthcare Provider Details

I. General information

NPI: 1831878719
Provider Name (Legal Business Name): LUIS ANGEL VAZQUEZ HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/08/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #2, KM. 119.2, INTERIOR, CAIMITAL ALTO
AGUADILLA PR
00603
US

IV. Provider business mailing address

227 CALLE OPALO
MOCA PR
00676-5416
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-6502
  • Fax:
Mailing address:
  • Phone: 787-477-5295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023390
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: