Healthcare Provider Details

I. General information

NPI: 1679284558
Provider Name (Legal Business Name): DR. JEAN G ACOSTA-VAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MORSE ESQUINA, 46 CALLE LA VALENTINA
ARROYO PR
00714
US

IV. Provider business mailing address

PO BOX 3191
GUAYAMA PR
00785-3191
US

V. Phone/Fax

Practice location:
  • Phone: 787-839-4150
  • Fax:
Mailing address:
  • Phone: 787-579-6096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7047
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7047
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: