Provider Demographics
NPI:1235238932
Name:VAZQUEZ LUNA, EFRAIN
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:VAZQUEZ LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19869
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1869
Mailing Address - Country:US
Mailing Address - Phone:787-727-4333
Mailing Address - Fax:787-268-7077
Practice Address - Street 1:PAVIA MEDICAL PLAZA 611
Practice Address - Street 2:CALLE PAVIA FERNANDEZ SUITE 205
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-727-4333
Practice Address - Fax:787-268-7077
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI41951Medicare UPIN