Provider Demographics
NPI:1639168420
Name:COLON VARGAS, IRIS M (MT)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:M
Last Name:COLON VARGAS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 CALLE KRUG
Mailing Address - Street 2:LABORATORIO TORREGROSA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1619
Mailing Address - Country:US
Mailing Address - Phone:787-728-5959
Mailing Address - Fax:787-728-5959
Practice Address - Street 1:75 CALLE KRUG
Practice Address - Street 2:LABORATORIO TORREGROSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1619
Practice Address - Country:US
Practice Address - Phone:787-728-5959
Practice Address - Fax:787-728-5959
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR651246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
O52062Medicare UPIN