Provider Demographics
NPI:1497971873
Name:RODRIGUEZ VARGAS, YADIRA
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:RODRIGUEZ VARGAS
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:URBANIZACION VELOMAS
Mailing Address - Street 2:CALLE CENTRAL COLOSO 206
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9611
Mailing Address - Country:US
Mailing Address - Phone:787-638-5534
Mailing Address - Fax:787-915-5492
Practice Address - Street 1:CONDOMINIO CARIBE MEDICAL PLAZA
Practice Address - Street 2:URB SANTA RITA PARCELAS J BO ESPINOSA SUITE M 101
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9611
Practice Address - Country:US
Practice Address - Phone:787-638-5534
Practice Address - Fax:787-915-5492
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist