Healthcare Provider Details

I. General information

NPI: 1699900134
Provider Name (Legal Business Name): PATRICIA VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15228 W COUNTRY GABLES DR
SURPRISE AZ
85379-7024
US

IV. Provider business mailing address

15228 W COUNTRY GABLES DR
SURPRISE AZ
85379-7024
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-5581
  • Fax:
Mailing address:
  • Phone: 623-546-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number636917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: