Provider Demographics
NPI:1275183501
Name:VARGAS, MARIANA SR
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:VARGAS
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ESTANCIAS DEL LAUREL
Mailing Address - Street 2:CALLE ACEROLA #3931
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2256
Mailing Address - Country:US
Mailing Address - Phone:787-446-8268
Mailing Address - Fax:
Practice Address - Street 1:URB. ESTANCIAS DEL LAUREL
Practice Address - Street 2:CALLE ACEROLA # 3931
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-0078
Practice Address - Country:US
Practice Address - Phone:787-446-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9611104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker