Provider Demographics
NPI:1407826944
Name:VAZQUEZ - SELLES, JOSE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:VAZQUEZ - SELLES
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:MEDICINA NUCLEAR RCM
Mailing Address - Street 2:PO BOX 29134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-758-3408
Mailing Address - Fax:787-622-7852
Practice Address - Street 1:HOSPITAL ONCOLOGICO PISO 4
Practice Address - Street 2:CENTRO MEDICO DE PUERTO RICO, BO. MONACILLOS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-754-3408
Practice Address - Fax:787-622-7852
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6892207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR261-60-FMedicare ID - Type Unspecified
PRUPIN # - E04103Medicare UPIN
8-2001-BMedicare ID - Type Unspecified