Provider Demographics
NPI:1306393228
Name:VAZQUEZ, IRVING (CPHT)
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 38874
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9422
Mailing Address - Country:US
Mailing Address - Phone:787-218-7266
Mailing Address - Fax:787-744-6889
Practice Address - Street 1:Q48 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6158
Practice Address - Country:US
Practice Address - Phone:787-218-7266
Practice Address - Fax:787-744-6889
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8748183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician