Provider Demographics
NPI:1679284558
Name:ACOSTA-VAZQUEZ, JEAN G
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:G
Last Name:ACOSTA-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:PO BOX 3191
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3191
Mailing Address - Country:US
Mailing Address - Phone:787-579-6096
Mailing Address - Fax:
Practice Address - Street 1:ARROYO TOWN CENTER, 800 PR-3
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-839-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist