Provider Demographics
NPI:1154615813
Name:MONSERRATE-VAZQUEZ, ANGEL LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:MONSERRATE-VAZQUEZ
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 1:1325 SAN MARCO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8567
Mailing Address - Country:US
Mailing Address - Phone:904-253-6910
Mailing Address - Fax:904-253-6964
Practice Address - Street 1:14540 OLD ST AUGUSTINE ROAD
Practice Address - Street 2:MEDICAL OFFICE BLDG II SUITE 2403
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258
Practice Address - Country:US
Practice Address - Phone:904-886-9686
Practice Address - Fax:904-253-6964
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130349207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine