Healthcare Provider Details

I. General information

NPI: 1821214255
Provider Name (Legal Business Name): JUAN E. VARGAS FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND. VILLAS PARQUE DE ESCORIAL EDIF. E APT. 1203
CAROLINA PR
00987
US

IV. Provider business mailing address

COND. VILLAS PARQUE DE ESCORIAL EDIF. E APT. 1203
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7521
  • Fax: 787-763-2480
Mailing address:
  • Phone: 787-763-7521
  • Fax: 787-763-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12712
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: