Provider Demographics
NPI:1932357159
Name:VAZQUEZ SERRANO, CARLOS A
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:VAZQUEZ SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 10947
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9502
Mailing Address - Country:US
Mailing Address - Phone:787-260-0335
Mailing Address - Fax:787-984-5334
Practice Address - Street 1:URBANIZACION EXTENSION LA FE
Practice Address - Street 2:CALLE SAN JUAN D 53
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-260-0335
Practice Address - Fax:787-984-5334
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 5063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059865Medicare PIN