Provider Demographics
NPI:1770226649
Name:VASQUEZ RENDEROS, DENNIS ALEXANDER
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ALEXANDER
Last Name:VASQUEZ RENDEROS
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 EXT SANTA JUANITA SECC 11
Mailing Address - Street 2:CALLE 1 D10
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5242
Mailing Address - Country:US
Mailing Address - Phone:787-234-6474
Mailing Address - Fax:
Practice Address - Street 1:URB EXT SANTA JUANITA SECC 11
Practice Address - Street 2:CALLE 1 D10
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-234-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant