Healthcare Provider Details

I. General information

NPI: 1699817031
Provider Name (Legal Business Name): ROSA MARIA VAZQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MEDICA 1 CARR.2 SUITE207
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 995
MANATI PR
00674-0995
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-9876
  • Fax: 787-884-7055
Mailing address:
  • Phone: 787-884-9876
  • Fax: 787-884-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13863
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: