Provider Demographics
NPI:1366466138
Name:VAZQUEZ RODRIGUEZ, MARINES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINES
Middle Name:
Last Name:VAZQUEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 CALLE VASALLO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1926
Mailing Address - Country:US
Mailing Address - Phone:787-948-5879
Mailing Address - Fax:
Practice Address - Street 1:274 CALLE CONVENTO
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3207
Practice Address - Country:US
Practice Address - Phone:787-725-5143
Practice Address - Fax:787-977-8424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15343207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-2634Medicare ID - Type Unspecified
PRI-19129Medicare UPIN