Provider Demographics
NPI:1336143064
Name:RODRIGUEZ VAZQUEZ, AIXA E (MD)
Entity Type:Individual
Prefix:DR
First Name:AIXA
Middle Name:E
Last Name:RODRIGUEZ VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PMB 185
Mailing Address - Street 2:PO BOX 30500
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-3050
Mailing Address - Country:US
Mailing Address - Phone:787-621-3400
Mailing Address - Fax:787-621-3401
Practice Address - Street 1:KM 47.7 CARR. 2
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5765
Practice Address - Country:US
Practice Address - Phone:787-621-3400
Practice Address - Fax:787-621-3401
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR10800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10800OtherLICENSE NUMBER
PRG41604Medicare UPIN