Healthcare Provider Details

I. General information

NPI: 1457395683
Provider Name (Legal Business Name): DR. EDUARDO RODRIGUEZ VAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 JOSE MENDEZ CARDONA AVE.
SAN SEBASTIAN PR
00685-0486
US

IV. Provider business mailing address

PO BOX 486
SAN SEBASTIAN PR
00685-0486
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax: 787-280-1698
Mailing address:
  • Phone: 787-896-1850
  • Fax: 787-280-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5222
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: