Healthcare Provider Details

I. General information

NPI: 1346232410
Provider Name (Legal Business Name): FREDDY MAS VARGAS MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 417 KM 3.0 BO. MALPASO
AGUADA PR
00602
US

IV. Provider business mailing address

PO BOX 745
AGUADA PR
00602-0745
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-4453
  • Fax: 787-868-0780
Mailing address:
  • Phone: 787-868-4453
  • Fax: 787-868-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number878
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number2977
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: