Healthcare Provider Details

I. General information

NPI: 1407126675
Provider Name (Legal Business Name): LUIS R HERNANDEZ VAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VITA CARE CLINICS 1801 AVE PONCE DE LEON
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 2222
ARECIBO PR
00613-2222
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-3000
  • Fax:
Mailing address:
  • Phone: 787-765-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18732
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number18732
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: