Provider Demographics
NPI:1508051723
Name:VAZQUEZ-BORRERO, ILEANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:
Last Name:VAZQUEZ-BORRERO
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 1:29 CALLE WASHINGTON
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1510
Mailing Address - Country:US
Mailing Address - Phone:787-723-3292
Mailing Address - Fax:787-723-3292
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-723-3292
Practice Address - Fax:787-723-3292
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist