Provider Demographics
NPI:1407364599
Name:VARGAS HERNANDEZ, GLADIANN DAMIL
Entity Type:Individual
Prefix:
First Name:GLADIANN
Middle Name:DAMIL
Last Name:VARGAS HERNANDEZ
Suffix:
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:HC 1 BOX 4321
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-9736
Mailing Address - Country:US
Mailing Address - Phone:787-598-6469
Mailing Address - Fax:
Practice Address - Street 1:CALLE JULIO CINTRON 202
Practice Address - Street 2:EDIFICIO GUAYACAN SUITE 219
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-598-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR152081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical