MEDICARE: JULIANA I CORREA VAZQUEZ

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	2355A2700X	Audiology Assistant	1011	PR

General Provider Information

NPI Number	:	1174040778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA I CORREA VAZQUEZ

Provider Business Mailing Address
First Line	:	PO BOX 193069
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-3069
Country	:	US
Telephone Number	:	787-761-0036
Fax Number	:	787-292-5050

Provider Business Practice Location Address
First Line	:	EL MOLINO SHOPPING CENTER
Second Line	:	LOCAL 1111, PR 54
City	:	GUAYAMA
State	:	PR
Zip	:	00784
Country	:	US
Telephone Number	:	787-864-3688
Fax Number	:	787-491-0286

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

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	05/23/2024

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