Provider Demographics
NPI:1245536036
Name:VARGAS, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:VARGAS
Suffix:
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 71474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:787-641-0773
Mailing Address - Fax:787-641-0797
Practice Address - Street 1:APS HEALTHCARE PUERTO RICO NO.2 CHARDON AVENUE
Practice Address - Street 2:SUITE 200A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8574
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:787-641-0797
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6791183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician