Provider Demographics
NPI:1326127887
Name:VAZQUEZ, GUSTAVO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:
Last Name:VAZQUEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GUSTAVO
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PACIFIC PLACE 1807
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-765-2003
Mailing Address - Fax:787-282-0869
Practice Address - Street 1:CALLE RVDO DOMINGO MARRERO NAVARRO NUM4
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-764-6892
Practice Address - Fax:787-282-0869
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9897207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology