Provider Demographics
NPI:1275874224
Name:VAZQUEZ, MARIMER
Entity Type:Individual
Prefix:
First Name:MARIMER
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION LOS ANGELES
Mailing Address - Street 2:CALLE NUMERO 20A
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-236-7294
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION BUZO CARRETERA 3
Practice Address - Street 2:NUMERO 443 SUITE 4
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-2828
Practice Address - Fax:787-852-4622
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3185183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician