Provider Demographics
NPI:1255370367
Name:VAZQUEZ GONZALEZ, CARLOS R (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:VAZQUEZ GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CONDOMINIO LOS PATRICIOS APT 1403
Mailing Address - Street 2:HS AVE SAN PATRICIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-679-2010
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE CUEVAS BUSTAMANTE
Practice Address - Street 2:PRIMER PISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3200
Practice Address - Country:US
Practice Address - Phone:787-248-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR21651207R00000X, 207RC0200X, 208M00000X, 207RP1001X
FLME78017207RC0200X
PR21561208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039279800Medicaid
FLF61656Medicare UPIN
FL256255300Medicaid