Healthcare Provider Details

I. General information

NPI: 1962220707
Provider Name (Legal Business Name): RUTH NAELIS FELICIANO VARGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 493 INT KM 1.3 CALLE LOS RODRIGUEZ SECTOR ORATORIO BO. CARRIZALES
HATILLO PR
00659-7331
US

IV. Provider business mailing address

PO BOX 141475
ARECIBO PR
00614-1475
US

V. Phone/Fax

Practice location:
  • Phone: 787-372-7777
  • Fax:
Mailing address:
  • Phone: 939-264-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7694
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: