Provider Demographics
NPI:1164482865
Name:VAZQUEZ-CORREA, MARISEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISEL
Middle Name:
Last Name:VAZQUEZ-CORREA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CALLE SAN JORGE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3310
Mailing Address - Country:US
Mailing Address - Phone:787-728-7775
Mailing Address - Fax:787-728-7755
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3310
Practice Address - Country:US
Practice Address - Phone:787-728-7775
Practice Address - Fax:787-728-7755
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR72932080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities