Provider Demographics
NPI:1275504961
Name:GONZALEZ VAZQUEZ, ORLANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:
Last Name:GONZALEZ VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ORLANDO
Other - Middle Name:
Other - Last Name:GONZALEZ VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1845 ROAD 2
Mailing Address - Street 2:BAYAMON MEDICAL PLAZA SUITE 510
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-620-6567
Mailing Address - Fax:787-620-6571
Practice Address - Street 1:1845 CARR 2
Practice Address - Street 2:BAYAMON MEDICAL PLAZA SUITE 510
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-620-6567
Practice Address - Fax:787-620-6571
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12494207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR207W00000XOtherOPHTHALMOLOGY
PRG91243Medicare UPIN