Provider Demographics
NPI:1407975576
Name:VAZQUEZ, MARTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:VAZQUEZ
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:PO BOX 51606
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1606
Mailing Address - Country:US
Mailing Address - Phone:787-530-2803
Mailing Address - Fax:
Practice Address - Street 1:2765 AVENIDA DOS PALMAS
Practice Address - Street 2:SUITE 204 OFICENTRO DOS PALMAS
Practice Address - City:LEVITTOWN
Practice Address - State:PR
Practice Address - Zip Code:00950
Practice Address - Country:US
Practice Address - Phone:787-261-0175
Practice Address - Fax:787-261-0175
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRJM846Medicaid