Provider Demographics
NPI:1215484290
Name:VAZQUEZ, CARLOS (4864958)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:4864958
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 9701
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9701
Mailing Address - Country:US
Mailing Address - Phone:787-513-7095
Mailing Address - Fax:
Practice Address - Street 1:386 CALLE SARRIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-1616
Practice Address - Country:US
Practice Address - Phone:787-513-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15101163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care