Provider Demographics
NPI:1265521355
Name:VAZQUEZ, SANDRA IVETTE (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:IVETTE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE RAFAEL CORDERO
Mailing Address - Street 2:P.M.B. 455 SUITE 140
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3740
Mailing Address - Country:US
Mailing Address - Phone:787-535-1001
Mailing Address - Fax:
Practice Address - Street 1:BO. RINCON SECTOR LOMAS
Practice Address - Street 2:SUITE 304
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG61905Medicare UPIN