Provider Demographics
NPI:1174713804
Name:VAZQUEZ ORTIZ, CARMEN A (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name:VAZQUEZ ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:A
Other - Last Name:VAZQUEZ ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:RIO CRISTAL ENCANTADA
Mailing Address - Street 2:RA 13, CALLE VIA DEL RIO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-505-1991
Mailing Address - Fax:
Practice Address - Street 1:RIO CRISTAL ENCANTADA
Practice Address - Street 2:RA 13 CALLE VIA DEL RIO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-505-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9998208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice