Healthcare Provider Details

I. General information

NPI: 1548755820
Provider Name (Legal Business Name): MARLYN V VARGAS RIVERA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MUNOZ RIVERA #31 ESQUINA BETANCES EDIF. DAGOBERTO MONTALVO SUITE #2
CABO ROJO PR
00623
US

IV. Provider business mailing address

URBANIZACION MANSIONES DE CABO ROJO 32 CALLEPLAYA
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-254-0396
  • Fax:
Mailing address:
  • Phone: 787-602-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6166
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: