Provider Demographics
NPI:1205878311
Name:VAZQUEZ VELAZQUEZ, LETICIA (MD)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:
Last Name:VAZQUEZ VELAZQUEZ
Suffix:
Gender:F
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 867
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0867
Mailing Address - Country:US
Mailing Address - Phone:787-645-3178
Mailing Address - Fax:
Practice Address - Street 1:CALLE SATURNINO RODRIGUEZ # 100
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00767
Practice Address - Country:UM
Practice Address - Phone:787-266-3337
Practice Address - Fax:787-266-3337
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10023208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-3673Medicare PIN
PRF96069Medicare UPIN