Provider Demographics
NPI:1891177424
Name:VAZQUEZ ZUBILLAGA, LUIS ANTONIO IVAN (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO IVAN
Last Name:VAZQUEZ ZUBILLAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190152
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0152
Mailing Address - Country:US
Mailing Address - Phone:787-238-2164
Mailing Address - Fax:
Practice Address - Street 1:1203 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0634
Practice Address - Country:US
Practice Address - Phone:787-238-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21276207R00000X
PR021276207RC0200X, 207RN0300X
PR31694-R390200000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program