Healthcare Provider Details

I. General information

NPI: 1821079070
Provider Name (Legal Business Name): DINAMARCA RODRIGUEZ VARGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST BANK BLDG 1519 AVE PONCE DE LEON STE 1101 P/23 SANTURCE
SAN JUAN PR
00910-9536
US

IV. Provider business mailing address

PO BOX 19536
SAN JUAN PR
00910-1536
US

V. Phone/Fax

Practice location:
  • Phone: 787-977-0707
  • Fax: 787-977-0708
Mailing address:
  • Phone: 787-977-0707
  • Fax: 787-977-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12901
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: