Provider Demographics
NPI:1518332394
Name:VAZQUEZ, JAILEEN
Entity type:Individual
Prefix:
First Name:JAILEEN
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 MCGRAW AVE APT 4F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-8005
Mailing Address - Country:US
Mailing Address - Phone:646-745-7212
Mailing Address - Fax:
Practice Address - Street 1:EE11 CALLE 19
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-6423
Practice Address - Country:US
Practice Address - Phone:787-388-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-05
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR010685183700000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No183700000XPharmacy Service ProvidersPharmacy Technician