Provider Demographics
NPI:1558099176
Name:VAZQUEZ, KEVIN (TS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 10851
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9737
Mailing Address - Country:US
Mailing Address - Phone:787-214-0044
Mailing Address - Fax:
Practice Address - Street 1:BO. GUAYABOTAS
Practice Address - Street 2:CARR. 182 KM 15.6
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-0767
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:787-739-8190
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR149071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical