Provider Demographics
NPI:1497723316
Name:VAZQUEZ, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
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:RR 14 BOX 5334
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9711
Mailing Address - Country:US
Mailing Address - Phone:787-730-3446
Mailing Address - Fax:787-279-3632
Practice Address - Street 1:167 ROAD KM 11
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9711
Practice Address - Country:US
Practice Address - Phone:787-730-3446
Practice Address - Fax:787-279-3632
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9999171100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPG3051OtherPALIC
PR500140EOtherMEDICARE Y MUCHO MAS
PRN198OtherFIRST PLUS
PR065480OtherCRUZ AZUL
PR6320088OtherHUMANA HEALTH PLAN
PR2081OtherAMERICAN HEALTH
PR82253OtherSSS
PR201279OtherUNION DE TRABAJADORES
PR065480OtherCRUZ AZUL
PR201279OtherUNION DE TRABAJADORES