Provider Demographics
NPI:1669004941
Name:CONNELLY VAQUER, OWEN PATRICK
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:PATRICK
Last Name:CONNELLY VAQUER
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 1:221 CALLE THEBE
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4668
Mailing Address - Country:US
Mailing Address - Phone:787-692-3930
Mailing Address - Fax:
Practice Address - Street 1:AVE. AMERICO MIRANDA CENTRO MEDICO DE PR EDIF PRINCIPAL
Practice Address - Street 2:ESCUELA DE MEDICINA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program