Provider Demographics
NPI:1093514168
Name:GARRASTEGUI- VAZQUEZ, LUIS JAVIER (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JAVIER
Last Name:GARRASTEGUI- VAZQUEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0382
Mailing Address - Country:US
Mailing Address - Phone:407-770-4960
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE PERAL N STE 3D
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4876
Practice Address - Country:US
Practice Address - Phone:407-770-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24236208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice