Provider Demographics
NPI:1912979063
Name:VAZQUEZ, RAFAEL ELISBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ELISBAN
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1508 CALLE MARBELLA
Mailing Address - Street 2:MANSIONES DE VISTAMAR MARINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1592
Mailing Address - Country:US
Mailing Address - Phone:787-776-9400
Mailing Address - Fax:787-776-9700
Practice Address - Street 1:AVE. ROBERTO CLEMENTE
Practice Address - Street 2:BLQ 111 LOCAL 1, #50
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-776-9400
Practice Address - Fax:787-776-9700
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14670208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-1339Medicare ID - Type Unspecified
PRI-02097Medicare UPIN