Provider Demographics
NPI:1790186690
Name:VAZQUEZ, JUAN SEBASTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:SEBASTIAN
Last Name:VAZQUEZ
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 1:8181 E TUFTS AVE
Mailing Address - Street 2:STE 560
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2559
Mailing Address - Country:US
Mailing Address - Phone:866-782-8393
Mailing Address - Fax:888-972-8596
Practice Address - Street 1:110 IRVING STREET NW
Practice Address - Street 2:SUITE G247
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062579208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program