Provider Demographics
NPI:1306803820
Name:VASQUEZ, LISETTE G (MD)
Entity type:Individual
Prefix:DR
First Name:LISETTE
Middle Name:G
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISETTE
Other - Middle Name:
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 CALLE TORREMOLINO
Mailing Address - Street 2:VILLAS DEL SOL
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5105
Mailing Address - Country:US
Mailing Address - Phone:787-478-9014
Mailing Address - Fax:
Practice Address - Street 1:307 CALLE TORREMOLINO
Practice Address - Street 2:VILLAS DEL SOL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5105
Practice Address - Country:US
Practice Address - Phone:787-478-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16131208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23838VAOtherTRIPLE-S