Provider Demographics
NPI:1114980133
Name:DE LA TORRE-VAZQUEZ, MARIA ISABEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:DE LA TORRE-VAZQUEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:I
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:AB5 CALLE NEBRASKA
Mailing Address - Street 2:URB. CAGUAS NOTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2240
Mailing Address - Country:US
Mailing Address - Phone:787-704-0421
Mailing Address - Fax:787-746-8551
Practice Address - Street 1:AB5 CALLE NEBRASKA
Practice Address - Street 2:URB. CAGUAS NOTE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2240
Practice Address - Country:US
Practice Address - Phone:787-704-0421
Practice Address - Fax:787-746-8551
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR142225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50482OtherPMC MEDICARE CHOICE
PRQ52444Medicare UPIN
PR57441Medicare ID - Type Unspecified