Provider Demographics
NPI:1275176844
Name:VAZQUEZ, GUSTAVO III (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:VAZQUEZ
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:
Other - Last Name:VAZQUEZ ZWEIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4 CALLE RVDO DOMINGO MARRERO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2118
Mailing Address - Country:US
Mailing Address - Phone:787-759-6901
Mailing Address - Fax:
Practice Address - Street 1:4 CALLE RVDO DOMINGO MARRERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2118
Practice Address - Country:US
Practice Address - Phone:787-759-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23499208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice