MEDICARE: LILLIAM ENID 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	208100000X	Physical Medicine & Rehabilitation Physician	914	PR

General Provider Information

NPI Number	:	1679675722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAM ENID VAZQUEZ

Provider Business Mailing Address
First Line	:	PO BOX 1886
Second Line	:
City	:	AIBONITO
State	:	PR
Zip	:	00705-1886
Country	:	US
Telephone Number	:	787-735-2445
Fax Number	:

Provider Business Practice Location Address
First Line	:	726 JOSE C VAZQUEZ
Second Line	:
City	:	AIBONITO
State	:	PR
Zip	:	00705
Country	:	US
Telephone Number	:	787-385-9441
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	02/27/2013

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