=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427116664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIGUEL ANGEL VARGAS VELEZ PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVENIDA LOS PATRIOTAS CARR. 111
-----------------------------------------------------
City | LARES PR
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-507-1181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 3 BOX 9833
-----------------------------------------------------
City | LARES
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00669-9514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-507-1181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2514
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------