Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 9237 | PR |
NPI | 1033190848 |
---|---|
Provider Name | Mrs. Carmen Lizzette Vargas |
First Address | Boqueron, PR 00622-0309 |
Second Address | Boqueron, PR 00622-0309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 07/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F37487 | (02) |