Provider Demographics
NPI:1205498839
Name:VAZQUEZ RIVERA, KATIANA MICHELLE (BS)
Entity type:Individual
Prefix:
First Name:KATIANA
Middle Name:MICHELLE
Last Name:VAZQUEZ RIVERA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 AVE LUIS MUNOZ RIVERA
Mailing Address - Street 2:COND AQUABLUE APT 2903
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-629-7859
Mailing Address - Fax:
Practice Address - Street 1:LAUREL AV STA JUANITA
Practice Address - Street 2:UNIVERSIDAD CENTRAL DEL CARIBE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-798-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program