Provider Demographics
NPI:1699139642
Name:VAZQUEZ, DALILA (RD)
Entity type:Individual
Prefix:MISS
First Name:DALILA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CALLE ARNALDO BRISTOL SUITE 7
Mailing Address - Street 2:EDIFICIO FISA PRIMER PIZO
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00786
Mailing Address - Country:US
Mailing Address - Phone:787-866-8886
Mailing Address - Fax:
Practice Address - Street 1:850 CALLE ARNALDO BRISTOL SUITE 7
Practice Address - Street 2:EDIFICIO FISA PRIMER PIZO
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00786
Practice Address - Country:US
Practice Address - Phone:787-866-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86033936133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered