Healthcare Provider Details

I. General information

NPI: 1396672689
Provider Name (Legal Business Name): AZAIRA COLON VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 PONCE BY PASS LOCAL A SUITE A URB. INDUSTRIAL REPARADA
PONCE PR
00716-0315
US

IV. Provider business mailing address

URB. HEDA LA MATILDE 5461 CALLE SURCO
PONCE PR
00728-2443
US

V. Phone/Fax

Practice location:
  • Phone: 787-223-2029
  • Fax:
Mailing address:
  • Phone: 787-247-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number001417
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: