1437253887 NPI number — DR. CARMEN J CASABLANCA VAZQUEZ OPTOMETRY DOCTOR

Table of content: DR. CARMEN J CASABLANCA VAZQUEZ OPTOMETRY DOCTOR (NPI 1437253887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437253887 NPI number — DR. CARMEN J CASABLANCA VAZQUEZ OPTOMETRY DOCTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASABLANCA VAZQUEZ
Provider First Name:
CARMEN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OPTOMETRY DOCTOR
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:
1437253887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PASEO DE LA REINA ST. #J-3
Provider Second Line Business Mailing Address:
MANSIONES REALES
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-789-5429
Provider Business Mailing Address Fax Number:
787-789-5429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 CALLE WASHINGTON
Provider Second Line Business Practice Location Address:
SUITE 407 ASHFORD MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-963-0700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006

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: 152WC0802X , with the licence number:  00204/0038 , 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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