MEDICARE: DR. MANUEL ENRIQUE VAZQUEZ MD

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	146D00000X	Personal Emergency Response Attendant	14671	PR
2	173000000X	Legal Medicine	14671	PR
3	208D00000X	General Practice Physician	14671	PR

General Provider Information

NPI Number	:	1861486144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL ENRIQUE VAZQUEZ MD

Provider Business Mailing Address
First Line	:	72 CALLE GARDENIA
Second Line	:	URB.CIUDAD JARDIN
City	:	CAROLINA
State	:	PR
Zip	:	00987-2206
Country	:	US
Telephone Number	:	787-750-1843
Fax Number	:	787-257-0995

Provider Business Practice Location Address
First Line	:	CALLE BAHUINIA, Z978 LOCAL A,
Second Line	:	LOIZA VALLEY
City	:	CANOVANAS
State	:	PR
Zip	:	00729
Country	:	US
Telephone Number	:	787-256-2853
Fax Number	:	787-257-0995

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	08/10/2016

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