Provider Demographics
NPI:1265416028
Name:LOJO-VAZQUEZ, JUAN J (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:J
Last Name:LOJO-VAZQUEZ
Suffix:
Gender:M
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 11698
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1698
Mailing Address - Country:US
Mailing Address - Phone:787-758-7781
Mailing Address - Fax:
Practice Address - Street 1:282 AVE PINERO
Practice Address - Street 2:207 EL AMAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-3921
Practice Address - Country:US
Practice Address - Phone:787-758-7781
Practice Address - Fax:787-758-7781
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4198208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77324Medicare UPIN
PR0025408Medicare ID - Type Unspecified