Provider Demographics
NPI:1629417803
Name:AGOSTO-VARGAS, YANERYS
Entity Type:Individual
Prefix:
First Name:YANERYS
Middle Name:
Last Name:AGOSTO-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 1:15015 CALLE VEREDA VERDE
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9622
Mailing Address - Country:US
Mailing Address - Phone:787-635-8047
Mailing Address - Fax:787-641-4561
Practice Address - Street 1:COND CAROLINA CT STE 308
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3501
Practice Address - Country:US
Practice Address - Phone:787-635-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29677R207R00000X
PR19284207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine