Provider Demographics
NPI:1518302652
Name:CLASS-VAZQUEZ, WALISBETH
Entity Type:Individual
Prefix:
First Name:WALISBETH
Middle Name:
Last Name:CLASS-VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D14 CALLE PARKSIDE 6 APT 906
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3338
Mailing Address - Country:US
Mailing Address - Phone:787-404-7820
Mailing Address - Fax:
Practice Address - Street 1:239 ARTERIAL HOSTOS AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1476
Practice Address - Country:US
Practice Address - Phone:939-484-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18885207R00000X, 207RG0100X
FL138622207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty