Provider Demographics
NPI:1609080803
Name:TRUYOL-VAZQUEZ, ENGRACIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ENGRACIA
Middle Name:
Last Name:TRUYOL-VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 AVE FD ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2143
Mailing Address - Country:US
Mailing Address - Phone:787-622-5687
Mailing Address - Fax:888-899-0977
Practice Address - Street 1:383 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2143
Practice Address - Country:US
Practice Address - Phone:787-622-5687
Practice Address - Fax:888-899-0977
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2634302R00000X
PR2643207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2634OtherSTATE LICENSE NUMBER
PRDM 02325-9OtherDM LOCAL LICENCE
PRDM 02325-9OtherDM LOCAL LICENCE
PRDM 02325-9OtherDM LOCAL LICENCE