MEDICARE: VICTOR I VARGAS SR. LPT

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	174400000X	Specialist	469	PR

General Provider Information

NPI Number	:	1497758700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR I VARGAS SR. LPT

Provider Business Mailing Address
First Line	:	110 DEL PARQUE ST
Second Line	:	12-A
City	:	SAN JUAN
State	:	PR
Zip	:	00911
Country	:	US
Telephone Number	:	787-644-5235
Fax Number	:	787-876-6823

Provider Business Practice Location Address
First Line	:	110 CALLE DEL PARQUE
Second Line	:	SUITE 12-A
City	:	SAN JUAN
State	:	PR
Zip	:	00911
Country	:	US
Telephone Number	:	787-644-5235
Fax Number	:	787-876-6823

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/09/2007

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Directions to “ VICTOR I VARGAS SR. LPT” Practice Location

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