Provider Demographics
NPI:1235312505
Name:DRA. DAISY VAZQUEZ DUBEAU OB-GYN CSP
Entity Type:Organization
Organization Name:DRA. DAISY VAZQUEZ DUBEAU OB-GYN CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-306-5800
Mailing Address - Street 1:PO BOX 195567
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5567
Mailing Address - Country:US
Mailing Address - Phone:787-766-1920
Mailing Address - Fax:
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 401
Practice Address - Street 2:DORAL BANK CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3769
Practice Address - Country:US
Practice Address - Phone:787-766-1920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10973261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty