Healthcare Provider Details

I. General information

NPI: 1336143064
Provider Name (Legal Business Name): AIXA E RODRIGUEZ VAZQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KM 47.7 CARR. 2
MANATI PR
00674-5765
US

IV. Provider business mailing address

PMB 185 PO BOX 30500
MANATI PR
00674-3050
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3400
  • Fax: 787-621-3401
Mailing address:
  • Phone: 787-621-3400
  • Fax: 787-621-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number10800
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10800
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerLICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: