Provider Demographics
NPI:1801173711
Name:VAZQUEZ, ROSALINE (LICENCES OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:ROSALINE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LICENCES OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2344
Mailing Address - Country:US
Mailing Address - Phone:787-428-5503
Mailing Address - Fax:
Practice Address - Street 1:65 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2344
Practice Address - Country:US
Practice Address - Phone:787-428-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR529156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician