MEDICARE: DR. MARIANA LOPEZ-VAZQUEZ 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	208000000X	Pediatrics Physician	15910	PR

General Provider Information

NPI Number	:	1568457802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANA LOPEZ-VAZQUEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3257
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00984-3257
Country	:	US
Telephone Number	:	787-215-1294
Fax Number	:

Provider Business Practice Location Address
First Line	:	DR. CLEMENTE FERNANDEZ STREET NUMBER 8
Second Line	:	1ST FLOOR
City	:	CAROLINA
State	:	PR
Zip	:	00984
Country	:	US
Telephone Number	:	787-276-6615
Fax Number	:	787-257-3370

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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