Provider Demographics
NPI:1508859380
Name:VAZQUEZ, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
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:PASEO SAN PABLO 100 EDIF ARTURO CADILLA
Mailing Address - Street 2:SUITE 511
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-780-2830
Mailing Address - Fax:787-786-8281
Practice Address - Street 1:PASEO SAN PABLO 100 EDIF ARTURO CADILLA
Practice Address - Street 2:SUITE 511
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-2830
Practice Address - Fax:787-786-8281
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5165207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26675Medicare ID - Type Unspecified
PRD83308Medicare UPIN