Provider Demographics
NPI:1821703216
Name:EMANUELLI VAZQUEZ, NATALIE IVELISSE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:IVELISSE
Last Name:EMANUELLI VAZQUEZ
Suffix:
Gender:F
Credentials:
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 360868
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0868
Mailing Address - Country:US
Mailing Address - Phone:787-600-9450
Mailing Address - Fax:
Practice Address - Street 1:CALLE NEVARES #36
Practice Address - Street 2:COND. LOS OLMOS APT 5-G
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-600-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2972333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy