Organization
ISSSO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOVANNA VAZQUEZ PAGAN (PRESIDENT)
(787) 403-7918
Entity
Organization
Contact information
Practice address
2 MEDICAL PLAZA 640, MAYAGUEZ, PR 00682
(787) 403-7810
Mailing address
732 CALLE DR ENRIQUE LAGUERRE, PONCE, PR 00731
(787) 403-7810
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
10070
PR
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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