1548701691 NPI number — CAROLINE E VAZQUEZ MELENDEZ LCDA

Table of content: CAROLINE E VAZQUEZ MELENDEZ LCDA (NPI 1548701691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548701691 NPI number — CAROLINE E VAZQUEZ MELENDEZ LCDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ MELENDEZ
Provider First Name:
CAROLINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCDA
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:
1548701691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 191670
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:
00919-1670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-920-4254
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CALLE BUCARE
Provider Second Line Business Practice Location Address:
CONDOMINIO PIAZETA APRT #5 PUNTA LAS MARIAS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00913-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-920-4254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2017

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: 133N00000X , with the licence number:  2004 , 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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