MEDICARE: DINAMARCA RODRIGUEZ VARGAS MD

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	207R00000X	Internal Medicine Physician	12901	PR

General Provider Information

NPI Number	:	1821079070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINAMARCA RODRIGUEZ VARGAS MD

Provider Business Mailing Address
First Line	:	PO BOX 19536
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-1536
Country	:	US
Telephone Number	:	787-977-0707
Fax Number	:	787-977-0708

Provider Business Practice Location Address
First Line	:	FIRST BANK BLDG 1519
Second Line	:	AVE PONCE DE LEON STE 1101 P/23 SANTURCE
City	:	SAN JUAN
State	:	PR
Zip	:	00910-9536
Country	:	US
Telephone Number	:	787-977-0707
Fax Number	:	787-977-0708

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	10/21/2016

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