Provider Demographics
NPI:1083436935
Name:VARGAS DE JESUS, NOELIA A
Entity type:Individual
Prefix:MRS
First Name:NOELIA
Middle Name:A
Last Name:VARGAS DE JESUS
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0906
Mailing Address - Country:US
Mailing Address - Phone:787-996-9821
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 906
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-0906
Practice Address - Country:US
Practice Address - Phone:787-650-1030
Practice Address - Fax:787-650-1076
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR94361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical