Healthcare Provider Details

I. General information

NPI: 1154585255
Provider Name (Legal Business Name): SANDRA ENID GALARZA-VARGAS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO TORRES SAN LUCAS SUITE 701
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 94
AGUIRRE PR
00704-0094
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-5577
  • Fax:
Mailing address:
  • Phone: 787-565-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number18227
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number18227
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: