Provider Demographics
NPI:1538717467
Name:AGUIRRE VARGAS, PRESBITERO (DO, P A)
Entity type:Individual
Prefix:
First Name:PRESBITERO
Middle Name:
Last Name:AGUIRRE VARGAS
Suffix:
Gender:M
Credentials:DO, P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 8168
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9844
Mailing Address - Country:US
Mailing Address - Phone:787-718-3938
Mailing Address - Fax:
Practice Address - Street 1:COMUNIDAD AGUILITA # 158 CALLE CORREA
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9844
Practice Address - Country:US
Practice Address - Phone:787-718-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR383-P.A.363AM0700X, 363AS0400X, 211D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical