Provider Demographics
NPI:1750664322
Name:VAZQUEZ, ANTONIO
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
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 LAUREL DEL SUR
Mailing Address - Street 2:CALLE BETANCES 1484
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00728-0000
Mailing Address - Country:US
Mailing Address - Phone:787-643-5786
Mailing Address - Fax:787-984-5334
Practice Address - Street 1:URB LAUREL DEL SUR
Practice Address - Street 2:CALLE BETANCES 1484
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00728-0000
Practice Address - Country:US
Practice Address - Phone:787-643-5786
Practice Address - Fax:787-984-5334
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance