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General NPI Number Information
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NPI Number | 1235832163
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Entity Type | Individual
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Provider Name | KENNETH SHAQUILLE VAZQUEZ
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Gender | Male
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 100 AVE LAUREL
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City | BAYAMON
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State | PR
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Zip | 00956-4816
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Country | US
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Telephone | 787-579-5581
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Fax |
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Provider Business Mailing Address
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Address Line | CARR #2 KM 8.2 JUAN SANCHEZ
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City | BAYAMON
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State | PR
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Zip | 00960
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Country | US
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Telephone | 787-579-5581
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Fax |
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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