Provider Demographics
NPI:1457395683
Name:RODRIGUEZ VAZQUEZ, EDUARDO
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:RODRIGUEZ VAZQUEZ
Suffix:
Gender:M
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 486
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0486
Mailing Address - Country:US
Mailing Address - Phone:787-896-1850
Mailing Address - Fax:787-280-1698
Practice Address - Street 1:3 JOSE MENDEZ CARDONA AVE.
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0486
Practice Address - Country:US
Practice Address - Phone:787-896-1850
Practice Address - Fax:787-280-1698
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5222208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE09040Medicare UPIN
PR0081070BMedicare ID - Type Unspecified