Provider Demographics
NPI:1235277153
Name:VAZQUEZ, ADELA ISABEL (BSPH)
Entity Type:Individual
Prefix:MRS
First Name:ADELA
Middle Name:ISABEL
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:BSPH
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 145
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:PR
Mailing Address - Zip Code:00721-0145
Mailing Address - Country:US
Mailing Address - Phone:787-887-2805
Mailing Address - Fax:787-887-2805
Practice Address - Street 1:URB BRISAS DEL MAR
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-889-4880
Practice Address - Fax:787-889-0410
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10251835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR050502OtherREGISTRATION
PR1025OtherPERMANENT LICENCE