Provider Demographics
NPI:1780752121
Name:VAZQUEZ, ENRIQUE D (MD,MBA)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:D
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CALLE LINDA SARA
Mailing Address - Street 2:MANSIONES DE MONTE VERDE
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4140
Mailing Address - Country:US
Mailing Address - Phone:787-535-1001
Mailing Address - Fax:787-535-1034
Practice Address - Street 1:APARTADO 373130, HOSPITAL MENONITA DE CAYEY
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-3130
Practice Address - Country:US
Practice Address - Phone:787-455-2588
Practice Address - Fax:787-535-1034
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist