Provider Demographics
NPI:1588651442
Name:VAZQUEZ BOTET, MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:VAZQUEZ BOTET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 AVE DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3719
Mailing Address - Country:US
Mailing Address - Phone:787-765-9598
Mailing Address - Fax:787-765-4103
Practice Address - Street 1:386 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3719
Practice Address - Country:US
Practice Address - Phone:787-765-9598
Practice Address - Fax:787-765-4103
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5662207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027190OtherMEDICARE NUMBER
PR26193OtherMEDICARE PROVIDER
PRD99557Medicare UPIN