Healthcare Provider Details

I. General information

NPI: 1033104179
Provider Name (Legal Business Name): LYMARI VARGAS-RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CALLE SERGIO CUEVAS
SAN JUAN PR
00918-2683
US

IV. Provider business mailing address

PMB 854 WINSTON CHURCILL URB CROWN HILLS 138
SAN JUAN PR
00926-0613
US

V. Phone/Fax

Practice location:
  • Phone: 787-407-1615
  • Fax: 787-759-0101
Mailing address:
  • Phone: 787-407-1615
  • Fax: 787-759-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15740
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: