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General NPI Number Information
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NPI Number | 1396788477
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Entity Type | Individual
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Provider Name | LOURDES VAZQUEZ MD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 65 INFANTRY STATION
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City | SAN JUAN
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State | PR
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Zip | 00929-2093
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Country | US
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Telephone | 787-728-6093
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 367083
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City | SAN JUAN
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State | PR
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Zip | 00936-7083
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Country | US
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Telephone | 787-728-6093
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Fax | 787-728-6093
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 11576
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License Number State | PR
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