Provider Demographics
NPI:1538290754
Name:VAZQUEZ-NIEVES, MIRELYS (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRELYS
Middle Name:
Last Name:VAZQUEZ-NIEVES
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:#39 URB COSTA NORTE
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9998
Mailing Address - Country:US
Mailing Address - Phone:787-544-4777
Mailing Address - Fax:787-544-4777
Practice Address - Street 1:CARR. 453 KM 0.5 SUITE 124
Practice Address - Street 2:BO. CARRIZALEZ MEDICAL & PROFESSIONAL PLAZA
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-9998
Practice Address - Country:US
Practice Address - Phone:787-544-4777
Practice Address - Fax:787-544-4777
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16174208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHI996AMedicare UPIN