Healthcare Provider Details

I. General information

NPI: 1497758700
Provider Name (Legal Business Name): VICTOR I VARGAS SR. LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CALLE DEL PARQUE SUITE 12-A
SAN JUAN PR
00911
US

IV. Provider business mailing address

110 DEL PARQUE ST 12-A
SAN JUAN PR
00911
US

V. Phone/Fax

Practice location:
  • Phone: 787-644-5235
  • Fax: 787-876-6823
Mailing address:
  • Phone: 787-644-5235
  • Fax: 787-876-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number469
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: