Provider Demographics
NPI:1902911357
Name:VAZQUEZ, ALEXEI (LND)
Entity Type:Individual
Prefix:MR
First Name:ALEXEI
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:LND
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 197
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-0197
Mailing Address - Country:US
Mailing Address - Phone:787-384-9135
Mailing Address - Fax:
Practice Address - Street 1:CARR. 779 KM. 5.5 SECTOR SOLIS
Practice Address - Street 2:BARRIO PALOMAS
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-0197
Practice Address - Country:US
Practice Address - Phone:787-384-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1427133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist