Healthcare Provider Details

I. General information

NPI: 1609080803
Provider Name (Legal Business Name): ENGRACIA TRUYOL-VAZQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 AVE FD ROOSEVELT
SAN JUAN PR
00918-2143
US

IV. Provider business mailing address

383 AVE FD ROOSEVELT
SAN JUAN PR
00918-2143
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-5687
  • Fax: 888-899-0977
Mailing address:
  • Phone: 787-622-5687
  • Fax: 888-899-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2634
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2643
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: