Basic Information
| Provider Information | |||||||||
| NPI: | 1780752121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAZQUEZ | ||||||||
| FirstName: | ENRIQUE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD,MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 CALLE LINDA SARA | ||||||||
| Address2: | MANSIONES DE MONTE VERDE | ||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007364140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
| FaxNumber: | 7875351034 | ||||||||
| Practice Location | |||||||||
| Address1: | APARTADO 373130, HOSPITAL MENONITA DE CAYEY | ||||||||
| Address2: | |||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007373130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874552588 | ||||||||
| FaxNumber: | 7875351034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 8414 | PR | Y | Other Service Providers | Specialist |
No ID Information.