Healthcare Provider Details

I. General information

NPI: 1124871983
Provider Name (Legal Business Name): JOSE LUIS VAZQUEZ COSME RN, MSN,CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA PALMERAS 312
SAN JUAN PR
00915
US

IV. Provider business mailing address

VILLA PALMERAS 312
SAN JUAN PR
00915
US

V. Phone/Fax

Practice location:
  • Phone: 787-945-9587
  • Fax:
Mailing address:
  • Phone: 787-945-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number004442
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: