Provider Demographics
NPI:1255967006
Name:SANCHEZ VAZQUEZ, LOURDES J
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:J
Last Name:SANCHEZ VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLL REMIGIO COLON 25103
Mailing Address - Street 2:CAYEY PUERTO RICO 00736
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9447
Mailing Address - Country:US
Mailing Address - Phone:787-553-0604
Mailing Address - Fax:
Practice Address - Street 1:CLL REMIGIO COLON 25103
Practice Address - Street 2:CAYEY PUERTO RICO 00736
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-9447
Practice Address - Country:US
Practice Address - Phone:787-553-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6577103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling