Provider Demographics
NPI:1265646855
Name:VAZQUEZ, LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
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:PO BOX 30532
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-8513
Mailing Address - Country:US
Mailing Address - Phone:787-884-0389
Mailing Address - Fax:787-621-3311
Practice Address - Street 1:CARR. #2 KM 47.7
Practice Address - Street 2:BO. COTTO NORTE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-8513
Practice Address - Country:US
Practice Address - Phone:787-884-0389
Practice Address - Fax:787-621-3311
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2085R0202X2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF39105Medicare UPIN
PR82549 VAMedicare ID - Type Unspecified