Provider Demographics
NPI:1346214640
Name:VAZQUEZ, MARIANO (NURSE)
Entity Type:Individual
Prefix:
First Name:MARIANO
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 2504
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9628
Mailing Address - Country:US
Mailing Address - Phone:787-843-2399
Mailing Address - Fax:
Practice Address - Street 1:URB. SANTA MARIA
Practice Address - Street 2:8024 CONCORDIA ST. SUITE 100
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-812-3318
Practice Address - Fax:787-290-3318
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9229383163W00000X
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse