Provider Demographics
NPI:1740399153
Name:VAZQUEZ ASTACIO, ESTEBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:
Last Name:VAZQUEZ ASTACIO
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 489
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0489
Mailing Address - Country:US
Mailing Address - Phone:787-790-6670
Mailing Address - Fax:787-857-0800
Practice Address - Street 1:2073 CALLE CLOTO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-0489
Practice Address - Country:US
Practice Address - Phone:787-857-0300
Practice Address - Fax:787-857-0800
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9276208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6606027292OtherMCS
PR7940009OtherHUMANA
PR400060OtherMMM
PR00351OtherMENONITA
PR065187OtherCRUZ AZUL
PR80920Medicare ID - Type UnspecifiedMEDICARE
PR065187OtherCRUZ AZUL