Provider Demographics
NPI:1598013948
Name:VAZQUEZ, IVAN (CVT)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:CVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 516
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:P.R.
Mailing Address - Zip Code:00739
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BO. HATO STREET 183 KM 7.9
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:P.R.
Practice Address - Zip Code:00754
Practice Address - Country:UM
Practice Address - Phone:787-943-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular