Provider Demographics
NPI:1851064307
Name:VAZQUEZ BRAGAN, PEDRO-JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO-JUAN
Middle Name:
Last Name:VAZQUEZ BRAGAN
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 1:186 PR 2 ACQUALINA 801
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-342-3026
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL SAN CRISTOBAL, CALLE ACEROLA, COTO LAUREL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-842-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22447207P00000X
PR15625I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15625IOtherMEDICAL INTERN AT HOSPITAL SAN CRISTOBAL