Provider Demographics
NPI:1619575735
Name:CASTRO VAZQUEZ, FABIOLA M
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:M
Last Name:CASTRO VAZQUEZ
Suffix:
Gender:F
Credentials:
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 193069
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3069
Mailing Address - Country:US
Mailing Address - Phone:787-761-0036
Mailing Address - Fax:787-292-5050
Practice Address - Street 1:TRIUMPH PLAZA LOTE #3
Practice Address - Street 2:CARRETERA ESTATAL #3 KM 83.6
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-285-4333
Practice Address - Fax:787-292-5050
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist