Healthcare Provider Details

I. General information

NPI: 1508902099
Provider Name (Legal Business Name): LILLIAN M. VARGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CYPRESS PKWY
KISSIMMEE FL
34759-3328
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-1400
  • Fax: 407-483-1405
Mailing address:
  • Phone: 407-447-7105
  • Fax: 407-770-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0047210
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME0047210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: