Provider Demographics
NPI:1902238835
Name:COSTAS VARGAS, DAISY E (PHL MS)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:E
Last Name:COSTAS VARGAS
Suffix:
Gender:F
Credentials:PHL MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 4 URB. EL MADRIGAL
Mailing Address - Street 2:F-7
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0000
Mailing Address - Country:US
Mailing Address - Phone:787-598-0323
Mailing Address - Fax:
Practice Address - Street 1:CALLE 4 URB. EL MADRIGAL
Practice Address - Street 2:F-7
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-1417
Practice Address - Country:US
Practice Address - Phone:787-598-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist