Provider Demographics
NPI:1245431634
Name:MARRERO VAZQUEZ, CARLOS MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MIGUEL
Last Name:MARRERO VAZQUEZ
Suffix:
Gender:M
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:PMB 791
Mailing Address - Street 2:AVE. WINSTON CHURCHILL #138
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6023
Mailing Address - Country:US
Mailing Address - Phone:787-766-2929
Mailing Address - Fax:787-908-5888
Practice Address - Street 1:CARR 199 LAS VISTAS SHOPPING VILLAGE
Practice Address - Street 2:SUITE 55
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5970
Practice Address - Country:US
Practice Address - Phone:787-766-2929
Practice Address - Fax:787-908-5888
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14702207V00000X, 207VG0400X, 207VH0002X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
25584Medicare UPIN