Provider Demographics
NPI:1730871989
Name:REYES VAZQUEZ, MARIELA ALEJANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:ALEJANDRA
Last Name:REYES VAZQUEZ
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 2087
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2087
Mailing Address - Country:US
Mailing Address - Phone:787-462-1418
Mailing Address - Fax:
Practice Address - Street 1:URB VALPARAISO CALLE 3 A20
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4014
Practice Address - Country:US
Practice Address - Phone:787-462-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
PR23979208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program