Healthcare Provider Details

I. General information

NPI: 1265237242
Provider Name (Legal Business Name): DAVID VARGAS MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID VARGAS MA

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 N JOHGN YOUNG PARKWAY
KISSIMMEE FL
33837
US

IV. Provider business mailing address

6 COTTONWOOD DR
DAVENPORT FL
33837-9742
US

V. Phone/Fax

Practice location:
  • Phone: 407-910-2941
  • Fax:
Mailing address:
  • Phone: 773-526-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: