Provider Demographics
NPI:1043201866
Name:VARGAS-MORALES, ABELARDO I (MD)
Entity Type:Individual
Prefix:
First Name:ABELARDO
Middle Name:I
Last Name:VARGAS-MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0059
Mailing Address - Country:US
Mailing Address - Phone:787-769-0045
Mailing Address - Fax:787-769-2977
Practice Address - Street 1:53 CALLE DOMINGO CACERES
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00628
Practice Address - Country:US
Practice Address - Phone:787-769-0045
Practice Address - Fax:787-769-2977
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5445208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026791Medicare ID - Type Unspecified
PRC77461Medicare UPIN