MEDICARE: FREDDY MAS VARGAS MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246QL0900X	Laboratory Management Specialist/Technologist	2977	PR
2	291U00000X	Clinical Medical Laboratory	878	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0031010	OTHER	PR	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	878	OTHER	PR	LABORATORIO CLINICO JERUSALEN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346232410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDDY MAS VARGAS MT

Provider Business Mailing Address
First Line	:	PO BOX 745
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602-0745
Country	:	US
Telephone Number	:	787-868-4453
Fax Number	:	787-868-0780

Provider Business Practice Location Address
First Line	:	ROAD 417 KM 3.0 BO. MALPASO
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602
Country	:	US
Telephone Number	:	787-868-4453
Fax Number	:	787-868-0780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	09/18/2024

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Directions to “ FREDDY MAS VARGAS MT” Practice Location

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