Provider Demographics
NPI:1669779575
Name:VAZQUEZ, MIGUEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3 CALLE ROSA
Mailing Address - Street 2:PARQUES DE SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6737
Mailing Address - Country:US
Mailing Address - Phone:787-635-8726
Mailing Address - Fax:
Practice Address - Street 1:N3 CALLE ROSA
Practice Address - Street 2:PARQUES DE SANTA MARIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6737
Practice Address - Country:US
Practice Address - Phone:787-635-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical