1184633042 NPI number — MRS. CARMEN S VAZQUEZ RIVERA RPT

Table of content: MRS. CARMEN S VAZQUEZ RIVERA RPT (NPI 1184633042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184633042 NPI number — MRS. CARMEN S VAZQUEZ RIVERA RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ RIVERA
Provider First Name:
CARMEN
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAZQUEZ
Provider Other First Name:
CARRMEN
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184633042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC - 4 BOX 42414
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOROVIS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00687-7025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-0165
Provider Business Mailing Address Fax Number:
787-854-0165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STREET 3 D-15 FLAMBOYAN URB.
Provider Second Line Business Practice Location Address:
OHARRIZ BLDG SUITE 2
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-0165
Provider Business Practice Location Address Fax Number:
787-854-0165
Provider Enumeration Date:
08/07/2006

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: 225100000X , with the licence number:  00708 , 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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