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General NPI Number Information
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NPI Number | 1093947780
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Entity Type | Organization
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Legal Business Name | ARMY
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 202 VINEYARD WAY APT. 601
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City | EVANS
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State | GA
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Zip | 30809
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Country | US
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Telephone | 787-914-6038
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 VINEYARD WAY
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City | EVANS
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State | GA
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Zip | 30809-9146
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Country | US
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Telephone | 787-914-6038
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Fax |
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Authorized Official
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Title or Position | PGY-1/TY
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Name | JAVIER M VAZQUEZ-ORTIZ
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Credential | MD
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Telephone | 787-914-6038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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