Healthcare Provider Details

I. General information

NPI: 1295655488
Provider Name (Legal Business Name): IXIA G VAZQUEZ VAZQUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CALLE JULIO CINTRON
AIBONITO PR
00705-3310
US

IV. Provider business mailing address

HC 2 BOX 13031
AIBONITO PR
00705-9600
US

V. Phone/Fax

Practice location:
  • Phone: 787-403-7557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3319
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: