Provider Demographics
NPI:1922028158
Name:VAZQUEZ GUZMAN, MIGUEL ANGEL LUIS
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL LUIS
Last Name:VAZQUEZ GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381FELISA RINCON
Mailing Address - Street 2:COND PASEO NORTE APT 104
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-763-3885
Mailing Address - Fax:
Practice Address - Street 1:6 CALLE PONCE
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-5021
Practice Address - Country:US
Practice Address - Phone:787-763-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13226207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI07939Medicare UPIN
PR0090228Medicare ID - Type Unspecified