Provider Demographics
NPI:1386835445
Name:FARGAS BERRIOS, NEICHMA SHAKYRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEICHMA
Middle Name:SHAKYRA
Last Name:FARGAS BERRIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CALLE 10
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3912
Mailing Address - Country:US
Mailing Address - Phone:787-602-4723
Mailing Address - Fax:
Practice Address - Street 1:UPR MEDICAL SCIENCES CAMPUS
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-756-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11705-I174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist