Basic Information
Provider Information | |||||||||
NPI: | 1447470356 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VAZQUEZ PEREZ | ||||||||
FirstName: | ERMELINDA | ||||||||
MiddleName: | Z | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 200 AVE RAFAEL CORDERO STE 140 | ||||||||
Address2: | PMB 718 | ||||||||
City: | CAGUAS | ||||||||
State: | PR | ||||||||
PostalCode: | 007254303 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7876043083 | ||||||||
FaxNumber: | 7878541452 | ||||||||
Practice Location | |||||||||
Address1: | AVE LUIS MUNOZ MARIN | ||||||||
Address2: | EDIF MERCANTIL CAGUAX APARTADO 425 | ||||||||
City: | CAGUAS | ||||||||
State: | PR | ||||||||
PostalCode: | 00725 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7876534401 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/26/2007 | ||||||||
LastUpdateDate: | 04/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 180814 | PR | N |   | Allopathic & Osteopathic Physicians | General Practice |   | 208D00000X | 11520 | PR | Y |   | Allopathic & Osteopathic Physicians | General Practice |   |
No ID Information.