1578354684 NPI number — DR. JEAN PAUL VAZQUEZ RIVERA OTD

Table of content: DR. JEAN PAUL VAZQUEZ RIVERA OTD (NPI 1578354684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578354684 NPI number — DR. JEAN PAUL VAZQUEZ RIVERA OTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ RIVERA
Provider First Name:
JEAN PAUL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OTD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAZQUEZ
Provider Other First Name:
JEAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578354684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
648 WASHINGTON ST APT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAINTREE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02184-5776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-208-8178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
648 WASHINGTON ST APT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-5776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-208-8178
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2025

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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