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General NPI Number Information
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NPI Number | 1427021880
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Entity Type | Organization
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Legal Business Name | CENTRO OFTALMOLOGICO DR VAZGUEZ DIAZ
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8111 CONCORDIA ST CONCORDIA PROFESSIONAL PLAZA SUITE 101
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-842-4188
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Fax | 787-842-4288
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Provider Business Mailing Address
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Address Line | PO BOX 9021
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City | PONCE
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State | PR
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Zip | 00732-9021
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Country | US
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Telephone | 787-842-4188
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Fax | 787-842-4288
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Authorized Official
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Title or Position | OWNER
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Name | JOSE ALFREDO VAZQUEZ
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Credential | MD BSB
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Telephone | 787-842-4188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 13059
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License Number State | PR
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