Provider Demographics
NPI:1518932722
Name:VARGAS CORDERO, ASTRID B (RPT)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:B
Last Name:VARGAS CORDERO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE BARBOSA #129
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-4880
Mailing Address - Fax:787-877-4880
Practice Address - Street 1:CALLE BARBOSA #129 (BAJOS)
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-4880
Practice Address - Fax:787-877-4880
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89229Medicare ID - Type Unspecified