Provider Demographics
NPI:1326161084
Name:DR PAOLI VARGAS MEDICAL GROUP
Entity Type:Organization
Organization Name:DR PAOLI VARGAS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PAOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-314-9703
Mailing Address - Street 1:BRISAS DEL PRADO
Mailing Address - Street 2:CALLE JILGUERO 2221
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2580
Mailing Address - Country:US
Mailing Address - Phone:787-314-9703
Mailing Address - Fax:
Practice Address - Street 1:BRISAS DEL PRADO
Practice Address - Street 2:CALLE JILGUERO 2221
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2580
Practice Address - Country:US
Practice Address - Phone:787-314-9703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR597107412OtherSS