Healthcare Provider Details

I. General information

NPI: 1588651442
Provider Name (Legal Business Name): MIGUEL VAZQUEZ BOTET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 AVE DOMENECH
SAN JUAN PR
00918-3719
US

IV. Provider business mailing address

386 AVE DOMENECH
SAN JUAN PR
00918-3719
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-9598
  • Fax: 787-765-4103
Mailing address:
  • Phone: 787-765-9598
  • Fax: 787-765-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5662
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: