Healthcare Provider Details

I. General information

NPI: 1922028158
Provider Name (Legal Business Name): MIGUEL ANGEL LUIS VAZQUEZ GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CALLE PONCE
HATO REY PR
00917-5003
US

IV. Provider business mailing address

381FELISA RINCON COND PASEO NORTE APT 104
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-6885
  • Fax:
Mailing address:
  • Phone: 787-763-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number13226
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number13226
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: