Provider Demographics
NPI:1417507138
Name:VARGAS VENERO, JORGE ALBERTO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ALBERTO
Last Name:VARGAS VENERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 24 O-2
Mailing Address - Street 2:ALTURAS DE FLAMBOYAN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-464-8042
Mailing Address - Fax:
Practice Address - Street 1:650 AVE LUIS MUNOZ RIVERA STE 701
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4110
Practice Address - Country:US
Practice Address - Phone:787-523-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist