Provider Demographics
NPI:1700776655
Name:VAZQUEZ DIAZ, IDA MARIA
Entity type:Individual
Prefix:MRS
First Name:IDA
Middle Name:MARIA
Last Name:VAZQUEZ DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB COLINAS DE JUNCOS
Mailing Address - Street 2:307 CALLE LA CEIBA
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9442
Mailing Address - Country:US
Mailing Address - Phone:787-368-9204
Mailing Address - Fax:
Practice Address - Street 1:URB COLINAS DE JUNCOS
Practice Address - Street 2:A-5 CALLE LA CEIBA
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-368-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist