Healthcare Provider Details

I. General information

NPI: 1588063200
Provider Name (Legal Business Name): YAMILA GOENAGA VAZQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYPASS STE 403
PONCE PR
00717
US

IV. Provider business mailing address

PO BOX 4055
PONCE PR
00733
US

V. Phone/Fax

Practice location:
  • Phone: 787-564-5380
  • Fax:
Mailing address:
  • Phone: 787-564-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number24679
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: