Provider Demographics
NPI:1730762691
Name:OCANA VAZQUEZ, EDEN (MD)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:OCANA VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 18 S-981
Mailing Address - Street 2:URB. ALTURAS DE RIO GRANDE
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-388-1746
Mailing Address - Fax:
Practice Address - Street 1:CALLE SERGIO CUEVAS BUSTAMANTE
Practice Address - Street 2:#550 AVE. ESQ. DOMENECH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program