Provider Demographics
NPI:1194876458
Name:VARGAS, ENID M (MT)
Entity type:Individual
Prefix:MRS
First Name:ENID
Middle Name:M
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA MARIA- HACIENDA CAMACHO
Mailing Address - Street 2:G6
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-1515
Mailing Address - Country:US
Mailing Address - Phone:787-835-2331
Mailing Address - Fax:787-836-4554
Practice Address - Street 1:BO. CUEVAS CARR 385 KM0.5
Practice Address - Street 2:SUITE 100
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-2669
Practice Address - Fax:787-836-4554
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1963246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management