Provider Demographics
NPI:1659392124
Name:VAZQUEZ AYALA, EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:VAZQUEZ AYALA
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:URB. VEREDAS
Mailing Address - Street 2:RESIDENCIA #688, VEREDA DE LOS CEDROS
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0000
Mailing Address - Country:US
Mailing Address - Phone:787-449-6084
Mailing Address - Fax:787-747-6530
Practice Address - Street 1:CENTRO AMBULATORIO HIMA SAN PABLO
Practice Address - Street 2:AVE. MUNOZ RIVERA A-1
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-653-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11449OtherDOCTORS STATE LICENCE