Healthcare Provider Details

I. General information

NPI: 1598886202
Provider Name (Legal Business Name): EDUARDO RODRIGUEZ VAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE SANTA CRUZ TORRE MEDICA SAN PABLO SUITE 901
BAYAMON PR
00961-7031
US

IV. Provider business mailing address

68 CALLE SANTA CRUZ TORRE MEDICA SAN PABLO SUITE 901
BAYAMON PR
00961-7031
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-0713
  • Fax: 787-740-0713
Mailing address:
  • Phone: 787-740-0713
  • Fax: 787-848-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number8748
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: