Provider Demographics
NPI:1669776431
Name:VAZQUEZ, MONICA DIONNE (MONICA VAZQUEZ,PHD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:DIONNE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MONICA VAZQUEZ,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 CALLE LA CORUNA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1356
Mailing Address - Country:US
Mailing Address - Phone:787-469-7256
Mailing Address - Fax:
Practice Address - Street 1:URB. BAIROA, CALLE SANTA MARIA M-3
Practice Address - Street 2:LOCAL 1
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-469-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical