Healthcare Provider Details

I. General information

NPI: 1730669797
Provider Name (Legal Business Name): JOSE ANIBAL SOLER-VARGAS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A19 URB S J BAUTISTA
MARICAO PR
00606
US

IV. Provider business mailing address

P O BOX 7
BOQUERON PR
00622
US

V. Phone/Fax

Practice location:
  • Phone: 787-380-3304
  • Fax:
Mailing address:
  • Phone: 787-380-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10316
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: