Provider Demographics
NPI:1477101236
Name:AVILES VARGAS, MARLENE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:E
Last Name:AVILES VARGAS
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 1:79 CALLE DON CHEMARY
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4120
Mailing Address - Country:US
Mailing Address - Phone:787-384-5938
Mailing Address - Fax:
Practice Address - Street 1:79 CALLE DON CHEMARY
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4120
Practice Address - Country:US
Practice Address - Phone:787-384-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21554208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice