Healthcare Provider Details

I. General information

NPI: 1346214640
Provider Name (Legal Business Name): MARIANO VAZQUEZ NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SANTA MARIA 8024 CONCORDIA ST. SUITE 100
PONCE PR
00717
US

IV. Provider business mailing address

HC 6 BOX 2504
PONCE PR
00731-9628
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3318
  • Fax: 787-290-3318
Mailing address:
  • Phone: 787-843-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9229383
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: