Healthcare Provider Details

I. General information

NPI: 1972956118
Provider Name (Legal Business Name): WENDY VARGAS PABON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CALLE MARINA
PONCE PR
00717
US

IV. Provider business mailing address

CARR. 101 BOX 184 COM. BETANCES
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-901-0479
  • Fax:
Mailing address:
  • Phone: 787-901-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number17748
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: