Provider Demographics
NPI:1124471743
Name:BOSQUES VARGAS, LINETTE (FAAP)
Entity type:Individual
Prefix:
First Name:LINETTE
Middle Name:
Last Name:BOSQUES VARGAS
Suffix:
Gender:F
Credentials:FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SABANERA DORADO
Mailing Address - Street 2:CAMINO DE LA TORRE 620
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-8395
Mailing Address - Country:US
Mailing Address - Phone:939-630-5413
Mailing Address - Fax:
Practice Address - Street 1:MANATI MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-631-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21011208D00000X, 208000000X
PR14235I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
21011OtherLICENCE