Basic Information
| Provider Information | |||||||||
| NPI: | 1851996557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAZQUEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ROBERTO | ||||||||
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| Mailing Information | |||||||||
| Address1: | HACIENDA LAS GARZAS #51 | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873089334 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4203 CALLE MARGINAL | ||||||||
| Address2: | |||||||||
| City: | FAJARDO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007383652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878601603 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2020 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6815 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.