Provider Demographics
NPI:1609962950
Name:VAZQUEZ SANTOS, JESUS M (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:VAZQUEZ SANTOS
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:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1336
Mailing Address - Country:US
Mailing Address - Phone:787-822-3446
Mailing Address - Fax:787-822-1622
Practice Address - Street 1:72 CALLE ARIZMENDI
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-2006
Practice Address - Country:US
Practice Address - Phone:787-822-3446
Practice Address - Fax:787-822-1622
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9521208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81754Medicare ID - Type Unspecified
PRE75402Medicare UPIN