Provider Demographics
NPI:1861796872
Name:VAZQUEZ, DAMARIS M (LND)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:F
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:STREET PRADERA # 162 ESTACIA DE LA FUENTE 00953
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3619
Mailing Address - Country:US
Mailing Address - Phone:787-467-6874
Mailing Address - Fax:787-251-4993
Practice Address - Street 1:PRADERA ST.
Practice Address - Street 2:162 ESTACIA DE LA FUENTE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3619
Practice Address - Country:US
Practice Address - Phone:787-467-6874
Practice Address - Fax:787-251-4993
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR942132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager