Provider Demographics
NPI:1265048789
Name:NATAL VAZQUEZ, JESSICA DEL MAR
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEL MAR
Last Name:NATAL 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:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1353
Mailing Address - Country:US
Mailing Address - Phone:787-903-6424
Mailing Address - Fax:
Practice Address - Street 1:APARTAMENTOS MAR CHIQUITA
Practice Address - Street 2:INT CARR 685 KM 5.0 APT #10
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0067
Practice Address - Country:US
Practice Address - Phone:787-903-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR70262355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty