Provider Demographics
NPI:1659867323
Name:OLIVERAS VAZQUEZ, YASDEL (MD)
Entity Type:Individual
Prefix:
First Name:YASDEL
Middle Name:
Last Name:OLIVERAS VAZQUEZ
Suffix:
Gender:F
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 1202
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1202
Mailing Address - Country:US
Mailing Address - Phone:787-981-5515
Mailing Address - Fax:
Practice Address - Street 1:CARR 690 KM 2.2 CERRO GORDO
Practice Address - Street 2:APT 1
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-981-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19965208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice