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General NPI Number Information
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NPI Number | 1770344970
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN ENDOCRINOLOGY, LLC
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | COND CAROLINA CT STE 308
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City | CAROLINA
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State | PR
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Zip | 00982-3501
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Country | US
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Telephone | 787-635-8047
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Fax |
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Provider Business Mailing Address
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Address Line | LAS HACIENDAS 1505 CALLE VEREDA VERDE
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | US
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Telephone | 787-635-8047
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Fax |
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Authorized Official
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Title or Position | MD
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Name | YANERYS AGOSTO-VARGAS
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Credential | MD
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Telephone | 787-635-8047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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