Provider Demographics
NPI:1184938367
Name:VAZQUEZ, BONNIE ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:ELIZABETH
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 AVE FERNANDEZ JUNCOS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-3004
Mailing Address - Country:US
Mailing Address - Phone:939-645-1711
Mailing Address - Fax:787-726-8396
Practice Address - Street 1:RG2 CALLE ALELI
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2606
Practice Address - Country:US
Practice Address - Phone:939-645-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2509101YP2500X
PR3826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional