=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780752121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ENRIQUE D VAZQUEZ MD,MBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | APARTADO 373130, HOSPITAL MENONITA DE CAYEY
-----------------------------------------------------
City | CAYEY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00737-3130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-455-2588
-----------------------------------------------------
Fax | 787-535-1034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 CALLE LINDA SARA MANSIONES DE MONTE VERDE
-----------------------------------------------------
City | CAYEY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00736-4140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-535-1001
-----------------------------------------------------
Fax | 787-535-1034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 8414
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------