1962496356 NPI number — MS. YEZENIA IVETTE VARGAS ROLDAN MPT

Table of content: MS. YEZENIA IVETTE VARGAS ROLDAN MPT (NPI 1962496356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962496356 NPI number — MS. YEZENIA IVETTE VARGAS ROLDAN MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGAS ROLDAN
Provider First Name:
YEZENIA
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962496356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-1667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-896-4080
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 CALLE ANDRES MENDEZ LICIAGA
Provider Second Line Business Practice Location Address:
PADUA BUILDING
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-896-4080
Provider Business Practice Location Address Fax Number:
787-896-4080
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1215 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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