Provider Demographics
NPI:1104801273
Name:VAZQUEZ-MALDONADO, JOSE ROY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ROY
Last Name:VAZQUEZ-MALDONADO
Suffix:
Gender:M
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:PASEO REAL
Mailing Address - Street 2:ZAFIRO D 54
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-404-1668
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE PRINCIPAL
Practice Address - Street 2:URB. BAY VIEW
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4269
Practice Address - Country:US
Practice Address - Phone:787-404-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR121872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFI596AMedicare UPIN
PR26266Medicare ID - Type UnspecifiedPROVIDER NUMBER