Provider Demographics
NPI:1184609901
Name:VAZQUEZ, NESTOR L (MD)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:L
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 56096
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6296
Mailing Address - Country:US
Mailing Address - Phone:787-807-1912
Mailing Address - Fax:787-807-1953
Practice Address - Street 1:CALLE # 2 KM 39.5 HOSP. WILMA VAZQUEZ
Practice Address - Street 2:SUITE 104
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694-7200
Practice Address - Country:US
Practice Address - Phone:787-807-1912
Practice Address - Fax:787-807-1953
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14126207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2187OtherAMERICAN HEALTH
PR22553OtherMEDICARE OPTIMO (SSS)
PR100562OtherCRUZ AZUL
PR4063OtherPMC MEDICARE CHOICE
PR22553OtherMEDICARE SELECTO (SSS)
PR22553OtherSSS
PR660488412COtherMAPFRE
PR602428OtherMMM
PR9590217OtherHUMANA
PR22553OtherCCC (SSS)
PRA522OtherIMC
PR100562OtherCRUZ AZUL
PR22553OtherMEDICARE SELECTO (SSS)