Provider Demographics
NPI:1710794052
Name:FERNANDEZ-VARGAS, ROBERTO (MA)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:FERNANDEZ-VARGAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT ROOSEVELT
Mailing Address - Street 2:471 CALLE EDDIE GRACIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2623
Mailing Address - Country:US
Mailing Address - Phone:787-717-1775
Mailing Address - Fax:
Practice Address - Street 1:1007 AVE MUNOZ RIVERA
Practice Address - Street 2:CONDOMINIO DARLINGTON SUITE 1200
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2726
Practice Address - Country:US
Practice Address - Phone:787-930-9942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2972103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist