Provider Demographics
NPI:1740393453
Name:VAZQUEZ SANTANA, VIDAL (MD)
Entity Type:Individual
Prefix:
First Name:VIDAL
Middle Name:
Last Name:VAZQUEZ SANTANA
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:PO BOX 363003
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3003
Mailing Address - Country:US
Mailing Address - Phone:787-977-0707
Mailing Address - Fax:787-977-0708
Practice Address - Street 1:1519 PONCE DE LEON AVE. PDA.23
Practice Address - Street 2:SUITE 1105 FIRST BANK BUILDING
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-977-0707
Practice Address - Fax:787-977-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8049207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4508049OtherUIA PROVIDER ID
PR1688OtherPMC PROVIDER ID
PR992650OtherMMM PROVIDER ID
PR066905OtherCRUZ AZUL PROVIDER ID
PR3156OtherAHP PROVIDER ID
PR80019OtherTRIPLE S PROVIDER ID
PRN121OtherIMC PROVIDER ID
PR220192OtherPREFERRED HEALTH PROV ID
PR80019OtherTRIPLE S PROVIDER ID
PR1688OtherPMC PROVIDER ID