Provider Demographics
NPI:1144472820
Name:VARGAS, JEIMY CAROLINA
Entity type:Individual
Prefix:MISS
First Name:JEIMY
Middle Name:CAROLINA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CALLE C
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5329
Mailing Address - Country:US
Mailing Address - Phone:787-562-0051
Mailing Address - Fax:787-784-0636
Practice Address - Street 1:AVENIDA LOS DOMINICOS LEVITVILLE SHOOPING CENTER
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-0270
Practice Address - Fax:787-784-0636
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6792183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician