Provider Demographics
NPI:1790038453
Name:VAZQUEZ, NOEMI (MT)
Entity type:Individual
Prefix:MRS
First Name:NOEMI
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MT
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 8594
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8594
Mailing Address - Country:US
Mailing Address - Phone:787-473-6753
Mailing Address - Fax:
Practice Address - Street 1:URB CAMINO DEL SOL
Practice Address - Street 2:305 CAMINO DE LA COLINA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-473-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7010291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory