MEDICARE: DR. JOSE ROY VAZQUEZ-MALDONADO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	12187	PR

General Provider Information

NPI Number	:	1104801273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ROY VAZQUEZ-MALDONADO M.D.

Provider Business Mailing Address
First Line	:	PASEO REAL
Second Line	:	ZAFIRO D 54
City	:	DORADO
State	:	PR
Zip	:	00646
Country	:	US
Telephone Number	:	787-404-1668
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 CALLE PRINCIPAL
Second Line	:	URB. BAY VIEW
City	:	CATANO
State	:	PR
Zip	:	00962-4269
Country	:	US
Telephone Number	:	787-404-1668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	08/19/2014

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