Provider Demographics
NPI:1699183376
Name:VAZQUEZ-VALENCIA, ESTEBAN MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:MANUEL
Last Name:VAZQUEZ-VALENCIA
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 1:257 CALLE MENDEZ VIGO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4905
Mailing Address - Country:US
Mailing Address - Phone:787-475-7660
Mailing Address - Fax:
Practice Address - Street 1:257 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4905
Practice Address - Country:US
Practice Address - Phone:787-278-0830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466563207W00000X
PR19136207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31511ROtherPUERTO RICO STATE LICENSING BOARD
PR19136OtherPR STATE MEDICAL LICENSE