Healthcare Provider Details

I. General information

NPI: 1982669677
Provider Name (Legal Business Name): LIZA B VAZQUEZ COBIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE CONVENTO
SANTURCE PR
00912-3207
US

IV. Provider business mailing address

PMB 211 352 AVE. SAN CLAUDIO
SAN JUAN PR
00926-4126
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-1113
  • Fax:
Mailing address:
  • Phone: 787-726-1113
  • Fax: 787-771-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number15900
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: