Healthcare Provider Details

I. General information

NPI: 1831108794
Provider Name (Legal Business Name): WALESKA VARGAS OLIVERAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 140 BO LLANADAS
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 2020 PMB 58
BARCELONETA PR
00617-2020
US

V. Phone/Fax

Practice location:
  • Phone: 787-970-0044
  • Fax: 787-970-0044
Mailing address:
  • Phone: 787-970-0044
  • Fax: 787-970-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15201
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: