Provider Demographics
NPI:1023819950
Name:SANTIAGO VARGAS, RUBY
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:SANTIAGO 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:C MATIENZO CINTRON
Mailing Address - Street 2:46 BO AMELIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00965
Mailing Address - Country:US
Mailing Address - Phone:787-237-2274
Mailing Address - Fax:
Practice Address - Street 1:AVE. PONCE DE LEON #75,
Practice Address - Street 2:BO. AMELIA,
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:787-237-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist