Basic Information
| Provider Information | |||||||||
| NPI: | 1306409784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGAS-MASSARI | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 S ORANGE AVE | ||||||||
| Address2: | STE 940 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328013234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213326947 | ||||||||
| FaxNumber: | 4072864515 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 CALLE DR BASORA N | ||||||||
| Address2: | |||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006804833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878340101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2019 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 14661-I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | ACN1367 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 21496 | PR | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.