Provider Demographics
NPI:1548783632
Name:VARGAS SANTIAGO, TATIANA VICED (MD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:VICED
Last Name:VARGAS SANTIAGO
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 1:4624 CALLE PAQUITO MONTANER
Mailing Address - Street 2:URB PERLA DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-449-7540
Mailing Address - Fax:
Practice Address - Street 1:917 AVENIDA TITO CASTRO
Practice Address - Street 2:HOSPITAL EPISCOPAL SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-449-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33307R208D00000X
PR21338208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice