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General NPI Number Information
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NPI Number | 1265772784
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Entity Type | Individual
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Provider Name | IVAN JAVIER VAZQUEZ TORRES PSY.D
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Gender | Male
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 31 CALLE MAYOR OFICINA 201
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City | PONCE
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State | PR
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Zip | 00731
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Country | US
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Telephone | 787-475-9524
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Fax |
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Provider Business Mailing Address
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Address Line | ADONAI 3362 CRUZ 203
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City | PONCE
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State | PR
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Zip | 00717-1621
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Country | US
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Telephone | 787-475-9524
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2452
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License Number State | PR
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