Provider Demographics
NPI:1447446067
Name:VAZQUEZ RIVERA, YADIRA (MD)
Entity type:Individual
Prefix:DR
First Name:YADIRA
Middle Name:
Last Name:VAZQUEZ RIVERA
Suffix:
Gender:F
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:PO BOX 1372
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-5372
Mailing Address - Country:US
Mailing Address - Phone:939-299-8168
Mailing Address - Fax:
Practice Address - Street 1:CARR 100 KM 6.6
Practice Address - Street 2:BO. MIRADERO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:939-299-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12411208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice