Healthcare Provider Details

I. General information

NPI: 1003961392
Provider Name (Legal Business Name): MR. FREDDY VAGAS SOTO I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CALLE BARBOSA
CABO ROJO PR
00623-4005
US

IV. Provider business mailing address

URBANIZACION CIBAO CALLE ANGEL FRANCO #8
CABO ROJO PUERTO RICO
00623
UM

V. Phone/Fax

Practice location:
  • Phone: 787-851-1270
  • Fax: 787-255-2050
Mailing address:
  • Phone: 787-207-7606
  • Fax: 787-255-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number004863
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: