Healthcare Provider Details

I. General information

NPI: 1013399138
Provider Name (Legal Business Name): NATALIA L RODRIGUEZ VAZQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 03/11/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON PARADA 37.5 CLINICAS SUBESPECIALIISTAS PEDIATRICAS PISO 1
SAN JUAN PR
00917-5032
US

IV. Provider business mailing address

PO BOX 353
SAN LORENZO PR
00754-0353
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-758-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19897
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number19897
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: