Provider Demographics
NPI:1588244438
Name:CINTRON VAZQUEZ, ELEDY (MD)
Entity type:Individual
Prefix:DR
First Name:ELEDY
Middle Name:
Last Name:CINTRON VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELEDY
Other - Middle Name:
Other - Last Name:CINTRON VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:URB JARDINES DE NARANJITO
Mailing Address - Street 2:CALLE TRINITARIA 138
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9999
Mailing Address - Country:US
Mailing Address - Phone:787-702-1100
Mailing Address - Fax:
Practice Address - Street 1:130 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3012
Practice Address - Country:US
Practice Address - Phone:787-869-7213
Practice Address - Fax:787-869-7213
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR006752OtherLICENCE