Provider Demographics
NPI:1861727216
Name:VARGAS PEREZ, WALESKA (LND)
Entity type:Individual
Prefix:
First Name:WALESKA
Middle Name:
Last Name:VARGAS PEREZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 12881
Mailing Address - Street 2:HC-03
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9724
Mailing Address - Country:US
Mailing Address - Phone:787-397-9576
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2 KM93.2 INT119
Practice Address - Street 2:BO. MEMBRILLO
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9724
Practice Address - Country:US
Practice Address - Phone:787-397-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1331133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist