Provider Demographics
NPI:1497758700
Name:VARGAS, VICTOR I SR (LPT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:I
Last Name:VARGAS
Suffix:SR
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DEL PARQUE ST
Mailing Address - Street 2:12-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-644-5235
Mailing Address - Fax:787-876-6823
Practice Address - Street 1:110 CALLE DEL PARQUE
Practice Address - Street 2:SUITE 12-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911
Practice Address - Country:US
Practice Address - Phone:787-644-5235
Practice Address - Fax:787-876-6823
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056793Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
PRQ-26020Medicare UPIN