Healthcare Provider Details

I. General information

NPI: 1215605761
Provider Name (Legal Business Name): JOSE ANIBAL VAZQUEZ GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 173
SAN GERMAN PR
00683
US

IV. Provider business mailing address

URB LOS CAOBOS 2209 MAGA STREET
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-1860
  • Fax:
Mailing address:
  • Phone: 787-923-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number23563
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: