Provider Demographics
NPI:1730669797
Name:SOLER-VARGAS, JOSE ANIBAL SR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANIBAL
Last Name:SOLER-VARGAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 7
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622
Mailing Address - Country:US
Mailing Address - Phone:787-380-3304
Mailing Address - Fax:
Practice Address - Street 1:A19 URB S J BAUTISTA
Practice Address - Street 2:
Practice Address - City:MARICAO
Practice Address - State:PR
Practice Address - Zip Code:00606
Practice Address - Country:US
Practice Address - Phone:787-380-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical