Provider Demographics
NPI:1609815935
Name:VAZQUEZ ANDINO, GUILLERMO J (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:J
Last Name:VAZQUEZ ANDINO
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:MANSIONES DE VILANOVA
Mailing Address - Street 2:CALLE C NUM. F124
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-756-7110
Mailing Address - Fax:787-756-7110
Practice Address - Street 1:MANSIONES DE VILANOVA
Practice Address - Street 2:CALLE C NUM. F124
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-756-7110
Practice Address - Fax:787-756-7110
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4742207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026301Medicare ID - Type Unspecified
PRE00143Medicare UPIN