Healthcare Provider Details

I. General information

NPI: 1124471743
Provider Name (Legal Business Name): LINETTE BOSQUES VARGAS FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 06/08/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI MEDICAL CENTER
MANATI PR
00674
US

IV. Provider business mailing address

URB SABANERA DORADO CAMINO DE LA TORRE 620
DORADO PR
00646-8395
US

V. Phone/Fax

Practice location:
  • Phone: 787-631-3700
  • Fax:
Mailing address:
  • Phone: 939-630-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21011
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14235I
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21011
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier21011
Identifier TypeOTHER
Identifier State
Identifier IssuerLICENCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: