Provider Demographics
NPI:1467763219
Name:VARGAS MARTINEZ, LUIS O
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:O
Last Name:VARGAS MARTINEZ
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 1:5347 AVENIDA ISLA VERDE
Mailing Address - Street 2:CONDOMINIO MAR BELLA DEL CARIBE DESTE APT 405
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:305-905-6575
Mailing Address - Fax:
Practice Address - Street 1:1456 CALLE ASIA
Practice Address - Street 2:
Practice Address - City:SAN JAUN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-641-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7999146N00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic