=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386037323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YARIMAR VARGAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2015
-----------------------------------------------------
Last Update Date | 03/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 CALLE CHIPRE EXTENSION SAN LUIS
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705-3146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-449-7803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 CALLE CHIPRE EXTENSION SAN LUIS
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705-3146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-449-7803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTA
-----------------------------------------------------
Name | MRS. YARIMAR VARGAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-449-7803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | PCVTE 4443
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------