Provider Demographics
NPI:1699817031
Name:VAZQUEZ, ROSA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name: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 995
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0995
Mailing Address - Country:US
Mailing Address - Phone:787-884-9876
Mailing Address - Fax:787-884-7055
Practice Address - Street 1:TORRE MEDICA 1
Practice Address - Street 2:CARR.2 SUITE207
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-9876
Practice Address - Fax:787-884-7055
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13863208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20661Medicare ID - Type Unspecified
PRH69231Medicare UPIN