Provider Demographics
NPI:1508474560
Name:VAZQUEZ OSORIO, JAN C (MLS(ASCP))
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:VAZQUEZ OSORIO
Suffix:
Gender:M
Credentials:MLS(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO PUEBLO 197 GUAYACAN
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-910-1376
Mailing Address - Fax:
Practice Address - Street 1:CARR. 681, KM 2.4 BO. ISLOTE SECTOR JAREALITOS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-910-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8849246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Single Specialty