Healthcare Provider Details

I. General information

NPI: 1801355086
Provider Name (Legal Business Name): JUAN IGNACIO VAZQUEZ FUSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI MEDICAL CENTER SUITE 203 668 CALLE HERNANDEZ CARRION
MANATI PR
00674-4652
US

IV. Provider business mailing address

MANATI MEDICAL CENTER SUITE 203 668 CALLE HERNANDEZ CARRION
MANATI PR
00674-4652
US

V. Phone/Fax

Practice location:
  • Phone: 787-918-0066
  • Fax:
Mailing address:
  • Phone: 787-918-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023483
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number023483
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number023483
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: