Provider Demographics
NPI:1346232410
Name:MAS VARGAS, FREDDY (MT)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:
Last Name:MAS VARGAS
Suffix:
Gender:M
Credentials:MT
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 745
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0745
Mailing Address - Country:US
Mailing Address - Phone:787-868-4453
Mailing Address - Fax:787-868-0780
Practice Address - Street 1:ROAD 417 KM 3.0 BO. MALPASO
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-4453
Practice Address - Fax:787-868-0780
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2977246QL0900X
PR878291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR878OtherLABORATORIO CLINICO JERUSALEN