Provider Demographics
NPI:1003069949
Name:VAZQUEZ, CARLOS JAVIER
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAVIER
Last Name:VAZQUEZ
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:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1085
Mailing Address - Country:US
Mailing Address - Phone:787-849-4173
Mailing Address - Fax:787-264-7171
Practice Address - Street 1:CARR#2 KM 164.0 INT.
Practice Address - Street 2:PLAZA MONSERRATE I
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-0749
Practice Address - Fax:787-849-3010
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5728183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician