Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 046169 | CT |
Y | 208600000X | Surgeon | 046169 | CT |
N | 2086S0105X | Surgery of the Hand | 046169 | CT |
N | 2086S0122X | Plastic and Reconstructive Surgery | 046169 | CT |
NPI | 1083889398 |
---|---|
Provider Name | Dr. Tito L. Vasquez |
First Address | Southport, CT 06890-1258 |
Second Address | Southport, CT 06890-1258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 02/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D300000073 | MEDICARE PTAN (01) | CT |