Provider Demographics
NPI:1922898832
Name:VARGAS, GLORIA E. MEDINA (OT)
Entity type:Individual
Prefix:
First Name:GLORIA E.
Middle Name:MEDINA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLINAS DE CUPEY
Mailing Address - Street 2:B 59 CALLE 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7524
Mailing Address - Country:US
Mailing Address - Phone:787-409-6331
Mailing Address - Fax:
Practice Address - Street 1:1225 MARGINAL VILLAMAR
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6345
Practice Address - Country:US
Practice Address - Phone:787-533-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR593225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist