Provider Demographics
NPI:1649454935
Name:RODRIGUEZ VARGAS, YADIRA SOCORRO (MD)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:SOCORRO
Last Name:RODRIGUEZ VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CALLE CEDRO
Mailing Address - Street 2:URB. LOS ROBLES
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4212
Mailing Address - Country:US
Mailing Address - Phone:787-317-0645
Mailing Address - Fax:
Practice Address - Street 1:170 CALLE CEDRO
Practice Address - Street 2:URB. LOS ROBLES
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4212
Practice Address - Country:US
Practice Address - Phone:787-317-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16875207R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16875OtherMEDICAL LIC NUMBER