Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1589 | PR |
NPI | 1255410429 |
---|---|
Provider Name | Wilson Vargas |
First Address | Vega Alta, PR 00692 |
Second Address | Vega Alta, PR 00692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |