MEDICARE: GLORIA E. MEDINA VARGAS OT

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	225X00000X	Occupational Therapist	593	PR

General Provider Information

NPI Number	:	1922898832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA E. MEDINA VARGAS OT

Provider Business Mailing Address
First Line	:	COLINAS DE CUPEY
Second Line	:	B 59 CALLE 1
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7524
Country	:	US
Telephone Number	:	787-409-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 MARGINAL VILLAMAR
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00979-6345
Country	:	US
Telephone Number	:	787-533-0923
Fax Number	:

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

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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