Provider Demographics
NPI:1962904631
Name:VAZQUEZ GOMEZ, BETSY (MD)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:VAZQUEZ GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 AV. JUAN PONCE DE LEON
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-339-2639
Mailing Address - Fax:
Practice Address - Street 1:1511 AVE PONCE DE LEON STE 3
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-5001
Practice Address - Country:US
Practice Address - Phone:787-339-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22818207QG0300X, 207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine