Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1166 | PR |
NPI | 1003885401 |
---|---|
Provider Name | Dr. Humberto Vazquez |
First Address | Guanica, PR 00653-0406 |
Second Address | Ponce, PR 00717-0211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 06/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41186 | TRIPLE S, INC. (01) | PR |