Provider Demographics
NPI:1962871731
Name:RIOS VAZQUEZ, MARIA TERESA (LND)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:RIOS VAZQUEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:MARIA T.
Other - Middle Name:RIOS
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LND
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-226-1176
Mailing Address - Fax:
Practice Address - Street 1:8169 CONDOMINIO SAN VICENTE
Practice Address - Street 2:SUIT 412 CALLE CONCORDIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-284-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1942133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist