=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578632097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHAKOS, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COND LA SIERRA DEL SOL APT-4
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-755-5813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COND LA SIERRA DEL SOL APT-4
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-755-5813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NESTOR L VAZQUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-485-7159
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 14126
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------