Healthcare Provider Details

I. General information

NPI: 1104801273
Provider Name (Legal Business Name): JOSE ROY VAZQUEZ-MALDONADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CALLE PRINCIPAL URB. BAY VIEW
CATANO PR
00962-4269
US

IV. Provider business mailing address

PASEO REAL ZAFIRO D 54
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-404-1668
  • Fax:
Mailing address:
  • Phone: 787-404-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12187
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: