Healthcare Provider Details

I. General information

NPI: 1114795648
Provider Name (Legal Business Name): AIDA V VARGAS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

IV. Provider business mailing address

PO BOX 11010
WATERBURY CT
06703-0010
US

V. Phone/Fax

Practice location:
  • Phone: 203-508-0026
  • Fax:
Mailing address:
  • Phone: 203-508-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number491
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: