Provider Demographics
NPI:1427266956
Name:VAZQUEZ-RODRIGUEZ, VICTOR J (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:VAZQUEZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:J
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5191
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-5191
Mailing Address - Country:US
Mailing Address - Phone:787-790-6718
Mailing Address - Fax:787-997-0123
Practice Address - Street 1:CARR 460 KM 0.2 BO CAIMITAL BAJO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4055
Practice Address - Country:US
Practice Address - Phone:787-882-3975
Practice Address - Fax:787-997-0123
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10679207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10679OtherLICENCE
PR40D0944775OtherCLIA NUMBER
PRG51782Medicare UPIN
PR89068Medicare ID - Type Unspecified
PR10679OtherLICENCE