Healthcare Provider Details

I. General information

NPI: 1194876458
Provider Name (Legal Business Name): ENID M. VARGAS M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. CUEVAS CARR 385 KM0.5 SUITE 100
PENUELAS PR
00624
US

IV. Provider business mailing address

URB. SANTA MARIA- HACIENDA CAMACHO G6
GUAYANILLA PR
00656-1515
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-2669
  • Fax: 787-836-4554
Mailing address:
  • Phone: 787-835-2331
  • Fax: 787-836-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number1963
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: