Provider Demographics
NPI:1215254487
Name:VAZQUEZ, GABRIEL A SR (10263)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:A
Last Name:VAZQUEZ
Suffix:SR
Gender:M
Credentials:10263
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CARR 151 RAM 562 BARRIO APEADERO
Mailing Address - Street 2:HC 01 BOX 3776
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9868
Mailing Address - Country:US
Mailing Address - Phone:787-612-3581
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL SERVICES SOLUTION EAI CORP
Practice Address - Street 2:BOX 2055
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2001
Practice Address - Country:US
Practice Address - Phone:787-929-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR102631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical