=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427266956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR J VAZQUEZ-RODRIGUEZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 05/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 460 KM 0.2 BO CAIMITAL BAJO
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00603-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-882-3975
-----------------------------------------------------
Fax | 787-997-0123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5191
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00605-5191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-790-6718
-----------------------------------------------------
Fax | 787-997-0123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 10679
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------