Provider Demographics
NPI:1942299110
Name:VAZQUEZ-VAZQUEZ, EFRAIN (MD)
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:VAZQUEZ-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:PO BOX 9137
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9137
Mailing Address - Country:US
Mailing Address - Phone:787-852-3045
Mailing Address - Fax:787-852-3045
Practice Address - Street 1:55 LUIS M MARIN ST
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-3045
Practice Address - Fax:787-852-3045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics