Provider Demographics
NPI:1598326753
Name:VAZQUEZ VAZQUEZ, MARIANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:VAZQUEZ VAZQUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:Y8 CALLE GREEN HILL
Mailing Address - Street 2:URB GARDEN HILLS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-234-5731
Mailing Address - Fax:
Practice Address - Street 1:Y8 CALLE GREEN HILL
Practice Address - Street 2:URB GARDEN HILLS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-234-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical