Healthcare Provider Details

I. General information

NPI: 1962322925
Provider Name (Legal Business Name): MOISES VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESTANCIAS DE MONTE GRANDE SENA J13
CABO ROJO PR
00623
US

IV. Provider business mailing address

ESTANCIAS DE MONTE GRANDE SENA J13
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-414-9776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number968043
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: