Basic Information
| Provider Information | |||||||||
| NPI: | 1467763219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGAS MARTINEZ | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5347 AVENIDA ISLA VERDE | ||||||||
| Address2: | CONDOMINIO MAR BELLA DEL CARIBE DESTE APT 405 | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059056575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1456 CALLE ASIA | ||||||||
| Address2: | |||||||||
| City: | SAN JAUN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876411616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2010 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146N00000X | 7999 | PR | N | Emergency Medical Service Providers | Emergency Medical Technician, Basic | 208D00000X | 7999 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.