Provider Demographics
NPI:1962730192
Name:FREDDY MAS VARGAS
Entity type:Organization
Organization Name:FREDDY MAS VARGAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MS MT/GENERAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAS VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-832-8385
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0745
Mailing Address - Country:US
Mailing Address - Phone:787-832-8385
Mailing Address - Fax:787-832-8385
Practice Address - Street 1:CARR 348 KM 4 HM 8
Practice Address - Street 2:BARRIO MALEZAS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-8385
Practice Address - Fax:787-832-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1191291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory