Healthcare Provider Details

I. General information

NPI: 1063805265
Provider Name (Legal Business Name): DIANA E VARGAS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 SW 56TH ST SUITE B-103
MIAMI FL
33165-7069
US

IV. Provider business mailing address

10250 SW 56TH ST SUITE B-103
MIAMI FL
33165-7069
US

V. Phone/Fax

Practice location:
  • Phone: 305-207-7333
  • Fax: 305-207-7444
Mailing address:
  • Phone: 305-207-7333
  • Fax: 305-207-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANA MARIA LLANA
Title or Position: BILLING
Credential:
Phone: 305-207-7333