Healthcare Provider Details

I. General information

NPI: 1235312505
Provider Name (Legal Business Name): DRA. DAISY VAZQUEZ DUBEAU OB-GYN CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CALLE CESAR GONZALEZ STE 401 DORAL BANK CENTER
SAN JUAN PR
00918-3769
US

IV. Provider business mailing address

PO BOX 195567
SAN JUAN PR
00919-5567
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-1920
  • Fax:
Mailing address:
  • Phone: 787-766-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number10973
License Number StatePR

VIII. Authorized Official

Name: GRISELLE MONTALVO
Title or Position: MANAGER
Credential:
Phone: 787-306-5800