Provider Demographics
NPI:1336967439
Name:VAZQUEZ HENAO, JOSE ANTONIO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:VAZQUEZ HENAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CALLE DR CUETO
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2877
Mailing Address - Country:US
Mailing Address - Phone:787-424-0714
Mailing Address - Fax:
Practice Address - Street 1:62 CALLE DR CUETO
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2877
Practice Address - Country:US
Practice Address - Phone:787-424-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program