1053516252 NPI number — MRS. JENIFFER M. VAZQUEZ GONZALEZ

Table of content: MRS. JENIFFER M. VAZQUEZ GONZALEZ (NPI 1053516252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053516252 NPI number — MRS. JENIFFER M. VAZQUEZ GONZALEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ GONZALEZ
Provider First Name:
JENIFFER
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1053516252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE TORTOSA 193
Provider Second Line Business Mailing Address:
ESTANCIAS CHALETS APT 1
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-2372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-313-0829
Provider Business Mailing Address Fax Number:
787-200-8030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE TORTOSA 193
Provider Second Line Business Practice Location Address:
ESTANCIAS CHALETS APT 1A1
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-313-0829
Provider Business Practice Location Address Fax Number:
787-200-8030
Provider Enumeration Date:
06/18/2007

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: 225100000X , with the licence number:  1374 , 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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