Provider Demographics
NPI:1093775454
Name:VAZQUEZ CHACON, SOFIA (PT, EMTB, USAR)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:VAZQUEZ CHACON
Suffix:
Gender:F
Credentials:PT, EMTB, USAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2083
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9083
Mailing Address - Country:US
Mailing Address - Phone:787-466-9466
Mailing Address - Fax:787-822-0710
Practice Address - Street 1:CARR 2 KM 87.1
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-466-9466
Practice Address - Fax:787-680-7303
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660632297OtherCIGNA
PR890415OtherMMM
PR660632297OtherMCS CLASSICARE
PR660632297OtherMCS
PR3304248OtherACAA
PR39425OtherPROSAM
PR5-6763OtherTRIPLE-S
PR6500002OtherHUMANA
PR660632297OtherCOSVIMED
PRPE4755OtherPALIC
PR6500002OtherHUMANA
PRPE4755OtherPALIC
PR6500002OtherHUMANA