Jorge Salvador Vazquez M.D., M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

12669 Issued in PR

Practice address

12214 Oakwood Dr
Lake Ridge, VA 22192-1910

Phone

(703) 490-8216

Fax

(703) 497-1547

NPI assigned

Jan 20, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295481600000",
    "number": "1730484908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12214 OAKWOOD DR",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221921910",
            "telephone_number": "703-490-8216",
            "fax_number": "703-497-1547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12214 OAKWOOD DR",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221921910",
            "telephone_number": "703-490-8216",
            "fax_number": "703-497-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZQUEZ M.D.",
        "first_name": "JORGE",
        "middle_name": "SALVADOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-20",
        "last_updated": "2011-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "12669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Lake Ridge, VA
• Providers in Lake Ridge, VA by specialty
• General Practice Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.