Provider Demographics
NPI:1548304298
Name:NIEVES VAZQUEZ, AIDA L (MD)
Entity type:Individual
Prefix:DR
First Name:AIDA
Middle Name:L
Last Name:NIEVES VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1357
Mailing Address - Country:US
Mailing Address - Phone:787-286-2800
Mailing Address - Fax:121-286-2805
Practice Address - Street 1:K3 CALLE ALELI
Practice Address - Street 2:URB. CARIBE GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3407
Practice Address - Country:US
Practice Address - Phone:787-586-5254
Practice Address - Fax:787-474-3051
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10163208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF18922Medicare UPIN
PRNI82530Medicare PIN