Provider Demographics
NPI:1083861520
Name:VAZQUEZ, YAZMIRA
Entity Type:Individual
Prefix:
First Name:YAZMIRA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND TERRA LINDA
Mailing Address - Street 2:BUZON 203
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-902-8230
Mailing Address - Fax:
Practice Address - Street 1:COND TERRA LINDA
Practice Address - Street 2:BUZON 203
Practice Address - City:TRUJUILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6128
Practice Address - Country:US
Practice Address - Phone:787-902-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1508183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician