Provider Demographics
NPI:1245239532
Name:VAZQUEZ, VANESSA LYNETTE
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LYNETTE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:LYNETTE
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1708 CALLE SAN GUILLERMO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6550
Mailing Address - Country:US
Mailing Address - Phone:787-758-3309
Mailing Address - Fax:787-794-9085
Practice Address - Street 1:40 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2443
Practice Address - Country:US
Practice Address - Phone:787-794-9085
Practice Address - Fax:787-794-9085
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41829OtherPROV #FOR BLUE CROSS
PR42148OtherPROVIDER NUMBER FORSSS