Provider Demographics
NPI:1851458814
Name:VAZQUEZ, FERNANDO J (PHD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:J
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PHD
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 361372
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1372
Mailing Address - Country:US
Mailing Address - Phone:787-765-5355
Mailing Address - Fax:787-765-5346
Practice Address - Street 1:1007 AVE MUNOZ RIVERA
Practice Address - Street 2:EDIFICIO DARLINGTON OFICINA 1001
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2717
Practice Address - Country:US
Practice Address - Phone:787-765-5355
Practice Address - Fax:787-765-5346
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR289103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical