Provider Demographics
NPI:1053516252
Name:VAZQUEZ GONZALEZ, JENIFFER M
Entity type:Individual
Prefix:MRS
First Name:JENIFFER
Middle Name:M
Last Name:VAZQUEZ GONZALEZ
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:CALLE TORTOSA 193
Mailing Address - Street 2:ESTANCIAS CHALETS APT 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2372
Mailing Address - Country:US
Mailing Address - Phone:787-313-0829
Mailing Address - Fax:787-200-8030
Practice Address - Street 1:CALLE TORTOSA 193
Practice Address - Street 2:ESTANCIAS CHALETS APT 1A1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2372
Practice Address - Country:US
Practice Address - Phone:787-313-0829
Practice Address - Fax:787-200-8030
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist