Healthcare Provider Details

I. General information

NPI: 1972531911
Provider Name (Legal Business Name): CARMEN VANESSA OQUENDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE RAMON GOMEZ S URB. PEREYO
HUMACAO PR
00791-3925
US

IV. Provider business mailing address

PASEO DEL RIO #500 BLVD DEL RIO APT 5201
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-585-7095
  • Fax:
Mailing address:
  • Phone: 787-852-4343
  • Fax: 787-285-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15112
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: