Provider Demographics
NPI:1548415235
Name:CLINICA DE OJOS MALDONADO VAZQUEZ
Entity Type:Organization
Organization Name:CLINICA DE OJOS MALDONADO VAZQUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINES
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-725-5143
Mailing Address - Street 1:146 CALLE VASALLO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1926
Mailing Address - Country:US
Mailing Address - Phone:787-725-5143
Mailing Address - Fax:787-977-8424
Practice Address - Street 1:275 CALLE CONVENTO
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3205
Practice Address - Country:US
Practice Address - Phone:787-725-5143
Practice Address - Fax:787-977-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15343207W00000X
PR15310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty