Provider Demographics
NPI:1639296981
Name:GINEBRA VAZQUEZ, JUAN MANUEL
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MANUEL
Last Name:GINEBRA VAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M19 CALLE RUBI
Mailing Address - Street 2:URB. LA PLATA
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4873
Mailing Address - Country:US
Mailing Address - Phone:787-383-9005
Mailing Address - Fax:787-714-2308
Practice Address - Street 1:CARR 171 KM 4.4
Practice Address - Street 2:BO. RINCO SEC NOGUERAS
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-383-9005
Practice Address - Fax:787-714-2308
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography