Healthcare Provider Details

I. General information

NPI: 1679675722
Provider Name (Legal Business Name): LILLIAM ENID VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 JOSE C VAZQUEZ
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 1886
AIBONITO PR
00705-1886
US

V. Phone/Fax

Practice location:
  • Phone: 787-385-9441
  • Fax:
Mailing address:
  • Phone: 787-735-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number914
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: