Provider Demographics
NPI:1831878719
Name:VAZQUEZ HERNANDEZ, LUIS ANGEL (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:VAZQUEZ HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CALLE OPALO
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-5416
Mailing Address - Country:US
Mailing Address - Phone:787-477-5295
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2, KM. 119.2, INTERIOR, CAIMITAL ALTO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023390208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice