Healthcare Provider Details

I. General information

NPI: 1265048789
Provider Name (Legal Business Name): JESSICA DEL MAR NATAL VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

APARTAMENTOS MAR CHIQUITA INT CARR 685 KM 5.0 APT #10
MANATI PR
00674-0067
US

IV. Provider business mailing address

PO BOX 1353
MANATI PR
00674-1353
US

V. Phone/Fax

Practice location:
  • Phone: 787-903-6424
  • Fax:
Mailing address:
  • Phone: 787-903-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7026
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: