Healthcare Provider Details

I. General information

NPI: 1982332912
Provider Name (Legal Business Name): RAMSES VARGAS DNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W BASELINE RD
MESA AZ
85202-5820
US

IV. Provider business mailing address

9236 W CHALCO MOUNTAIN CT
CASA GRANDE AZ
85194-7567
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-5422
  • Fax:
Mailing address:
  • Phone: 520-840-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number278630
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierD09301055
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: