1730369596 NPI number — MRS. MEISALI MARIEL VAZQUEZ M.D.

Table of content: MRS. MEISALI MARIEL VAZQUEZ M.D. (NPI 1730369596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730369596 NPI number — MRS. MEISALI MARIEL VAZQUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ
Provider First Name:
MEISALI
Provider Middle Name:
MARIEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730369596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 CALLE DE DIEGO
Provider Second Line Business Mailing Address:
APTO. 106, AVENIDA DE DIEGO
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00923-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-466-8422
Provider Business Mailing Address Fax Number:
787-752-8957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA DE DIEGO 444
Provider Second Line Business Practice Location Address:
CONDOMINIO DE DIEGO, APTO 106
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-466-8422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  9332 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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