Healthcare Provider Details

I. General information

NPI: 1215254487
Provider Name (Legal Business Name): GABRIEL A VAZQUEZ SR. 10263
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL SERVICES SOLUTION EAI CORP BOX 2055
SALINAS PR
00751-2001
US

IV. Provider business mailing address

CARR 151 RAM 562 BARRIO APEADERO HC 01 BOX 3776
VILLALBA PR
00766-9868
US

V. Phone/Fax

Practice location:
  • Phone: 787-929-4556
  • Fax:
Mailing address:
  • Phone: 787-612-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10263
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: