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General NPI Number Information
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NPI Number | 1003885401
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Entity Type | Individual
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Provider Name | HUMBERTO VAZQUEZ D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | URB MARIANI 1577 -MUNOZ RIVERA AVE. SUITE 2
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City | PONCE
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State | PR
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Zip | 00717-0211
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Country | US
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Telephone | 787-840-5515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 406
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City | GUANICA
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State | PR
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Zip | 00653-0406
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Country | US
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Telephone | 787-841-5515
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Fax | 787-841-5515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1166
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License Number State | PR
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