Provider Demographics
NPI:1578234126
Name:VAZQUEZ, LUZ ENEIDA I (TERAPIA OCUPACIONAL)
Entity Type:Individual
Prefix:MISS
First Name:LUZ
Middle Name:ENEIDA
Last Name:VAZQUEZ
Suffix:I
Gender:F
Credentials:TERAPIA OCUPACIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIO CORAZON
Mailing Address - Street 2:CALLE CANDELARIA BUZON 34A PANEL #7
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-4240
Mailing Address - Country:US
Mailing Address - Phone:787-501-4730
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 KM 152.1
Practice Address - Street 2:PARADA 16
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-410-6076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR531225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15573XOtherINSURANCE