Provider Demographics
NPI:1316193147
Name:VAZQUEZ, BRIDGET JARINELLE (MT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:JARINELLE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 14 BOX 5334
Mailing Address - Street 2:BO DAJAOS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9711
Mailing Address - Country:US
Mailing Address - Phone:787-730-7777
Mailing Address - Fax:
Practice Address - Street 1:CALLE 1 # 829
Practice Address - Street 2:BO PINAS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-1837
Practice Address - Country:US
Practice Address - Phone:787-730-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6789291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory