Provider Demographics
NPI:1073586053
Name:VARGAS VALDEZ, WELLINGTON (MD)
Entity Type:Individual
Prefix:DR
First Name:WELLINGTON
Middle Name:
Last Name:VARGAS VALDEZ
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:BOSQUE DEL LAGO PLAZA 8
Mailing Address - Street 2:BC 25
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6039
Mailing Address - Country:US
Mailing Address - Phone:787-647-4307
Mailing Address - Fax:
Practice Address - Street 1:PMB 108 2135
Practice Address - Street 2:SUITE 15 CARR 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5259
Practice Address - Country:US
Practice Address - Phone:787-779-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10691208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083301Medicare ID - Type UnspecifiedPROVIDER NUMBER