Provider Demographics
NPI:1326039256
Name:VARGAS RODRIGUEZ MD, JOAQUIN (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:VARGAS RODRIGUEZ MD
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 1:1680 CALLE MANZANILLO
Mailing Address - Street 2:URB VENUS GDNS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4634
Mailing Address - Country:US
Mailing Address - Phone:787-760-3252
Mailing Address - Fax:
Practice Address - Street 1:1680 CALLE MANZANILLO
Practice Address - Street 2:URB VENUS GDNS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4634
Practice Address - Country:US
Practice Address - Phone:787-760-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3645208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0206-3 D.M.OtherP.R. NARCOTICS REGISTRY
PR3645OtherPUERTO RICO STATE LICENSE
PR217358OtherP.R. DRIVER'S LICENSE
AV4643981OtherDEA I.D.
PR217358OtherP.R. DRIVER'S LICENSE
D 38173Medicare UPIN