1740393453 NPI number — VIDAL VAZQUEZ SANTANA M.D.

Table of content: VIDAL VAZQUEZ SANTANA M.D. (NPI 1740393453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740393453 NPI number — VIDAL VAZQUEZ SANTANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ SANTANA
Provider First Name:
VIDAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1740393453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-977-0707
Provider Business Mailing Address Fax Number:
787-977-0708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 PONCE DE LEON AVE. PDA.23
Provider Second Line Business Practice Location Address:
SUITE 1105 FIRST BANK BUILDING
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-977-0707
Provider Business Practice Location Address Fax Number:
787-977-0708
Provider Enumeration Date:
08/16/2006

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: 207RC0000X , with the licence number:  8049 , 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)

  • Identifier: 4508049 . This is a "UIA PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1688 . This is a "PMC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 992650 . This is a "MMM PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 066905 . This is a "CRUZ AZUL PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3156 . This is a "AHP PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 80019 . This is a "TRIPLE S PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: N121 . This is a "IMC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 220192 . This is a "PREFERRED HEALTH PROV ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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