Provider Demographics
NPI:1750389573
Name:VAZQUEZ-DIAZ, PIO SR (MDM)
Entity type:Individual
Prefix:DR
First Name:PIO
Middle Name:
Last Name:VAZQUEZ-DIAZ
Suffix:SR
Gender:M
Credentials:MDM
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 519
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0519
Mailing Address - Country:US
Mailing Address - Phone:787-864-7172
Mailing Address - Fax:787-864-7172
Practice Address - Street 1:CALLE GENARO CUATIO #7
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-7172
Practice Address - Fax:787-864-7172
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice