Provider Demographics
NPI:1801989827
Name:VARGAS, DIONEL SR (MD)
Entity type:Individual
Prefix:
First Name:DIONEL
Middle Name:
Last Name:VARGAS
Suffix:SR
Gender:M
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:PO BOX 1859
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-6551
Mailing Address - Fax:787-877-6551
Practice Address - Street 1:HOSPITAL SAN CARLOS BORROMEO
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00626
Practice Address - Country:US
Practice Address - Phone:787-877-8000
Practice Address - Fax:787-877-8000
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7676208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
29285Medicare ID - Type Unspecified
E09034Medicare UPIN