Healthcare Provider Details

I. General information

NPI: 1316411507
Provider Name (Legal Business Name): RALDY JOSE VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 62.7 BO SABANA HOYOS
ARECIBO PR
00612
US

IV. Provider business mailing address

D3 CALLE MAGA UNIVERSITY GARDEN
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-881-2440
  • Fax:
Mailing address:
  • Phone: 787-375-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number11447
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: