Provider Demographics
NPI:1235137589
Name:DE JESUS VARGAS, LUIS ALFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALFREDO
Last Name:DE JESUS VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8127
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8127
Mailing Address - Country:US
Mailing Address - Phone:787-743-0236
Mailing Address - Fax:787-745-6176
Practice Address - Street 1:64 GOYCO STREET
Practice Address - Street 2:MUNOZ RIVERA CORNER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-0236
Practice Address - Fax:787-745-6176
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06501207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD26698Medicare UPIN