Provider Demographics
NPI:1528433927
Name:VAZQUEZ BONILLA, MARGGIE E (RN)
Entity type:Individual
Prefix:
First Name:MARGGIE
Middle Name:E
Last Name:VAZQUEZ BONILLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 ARENAS STREET
Mailing Address - Street 2:URB. VALLE COSTERO
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-475-4403
Mailing Address - Fax:
Practice Address - Street 1:3205 ARENAS STREET
Practice Address - Street 2:URB. VALLE COSTERO
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-475-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR71800163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice