1184609901 NPI number — DR. NESTOR L VAZQUEZ MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184609901 NPI number — DR. NESTOR L VAZQUEZ MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

VAZQUEZ

Provider First Name:

NESTOR

Provider Middle Name:

L

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1184609901

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/31/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 56096

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BAYAMON

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00960-6296

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-807-1912

Provider Business Mailing Address Fax Number:

787-807-1953

Provider First Line Business Practice Location Address:

CALLE # 2 KM 39.5 HOSP. WILMA VAZQUEZ

Provider Second Line Business Practice Location Address:

SUITE 104

Provider Business Practice Location Address City Name:

VEGA BAJA

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00694-7200

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-807-1912

Provider Business Practice Location Address Fax Number:

787-807-1953

Provider Enumeration Date:

12/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  14126 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2187 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 22553 . This is a "MEDICARE OPTIMO (SSS)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 100562 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 4063 . This is a "PMC MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 22553 . This is a "MEDICARE SELECTO (SSS)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 22553 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 660488412C . This is a "MAPFRE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 602428 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 9590217 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 22553 . This is a "CCC (SSS)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: A522 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".