1720154750 NPI number — MR. GILBERTO VAZQUEZ PEREZ MD

Table of content: JESSICA MURILLO PTA (NPI 1609267699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720154750 NPI number — MR. GILBERTO VAZQUEZ PEREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ PEREZ
Provider First Name:
GILBERTO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1720154750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 72 BOX 3951
Provider Second Line Business Mailing Address:
D1
Provider Business Mailing Address City Name:
NARANJITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00719-8771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-869-4721
Provider Business Mailing Address Fax Number:
787-869-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 803 KM 8.9
Provider Second Line Business Practice Location Address:
BO CEDRO ARRIBA
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719-8771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-869-4721
Provider Business Practice Location Address Fax Number:
787-869-0536
Provider Enumeration Date:
11/28/2006

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: 208D00000X , with the licence number:  11436 , 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: 080106 . This is a "LA CRUZ AZUL DE PR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26781 . This is a "ASOCIACION DE MAESTROS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87628 . This is a "MEDICARE OPTIMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87628 . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03946 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2011407 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400288 . This is a "MEDICARE Y MUCHO MAS" identifier . This identifiers is of the category "OTHER".




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