Provider Demographics
NPI:1790033819
Name:VAZQUEZ-MENDEZ, THAY AN MARIE (PH D)
Entity Type:Individual
Prefix:DR
First Name:THAY
Middle Name:AN MARIE
Last Name:VAZQUEZ-MENDEZ
Suffix:
Gender:F
Credentials:PH D
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 123
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0123
Mailing Address - Country:US
Mailing Address - Phone:787-675-2029
Mailing Address - Fax:
Practice Address - Street 1:STREET 111 KM 3.5
Practice Address - Street 2:SUITE #15 EDIFICIO VALE COLON
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-551-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical