Provider Demographics
NPI:1073847646
Name:VAZQUEZ, MELISSA (LND)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116A-19 CALLE 73C
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4119
Mailing Address - Country:US
Mailing Address - Phone:939-639-5091
Mailing Address - Fax:
Practice Address - Street 1:116A-19 CALLE 73C
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4119
Practice Address - Country:US
Practice Address - Phone:939-639-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1439133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered