Provider Demographics
NPI:1861486144
Name:VAZQUEZ, MANUEL ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ENRIQUE
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 1:72 CALLE GARDENIA
Mailing Address - Street 2:URB.CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2206
Mailing Address - Country:US
Mailing Address - Phone:787-750-1843
Mailing Address - Fax:787-257-0995
Practice Address - Street 1:CALLE BAHUINIA, Z978 LOCAL A,
Practice Address - Street 2:LOIZA VALLEY
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-2853
Practice Address - Fax:787-257-0995
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14671146D00000X, 173000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21338Medicare ID - Type Unspecified
PRH 98373Medicare UPIN