Healthcare Provider Details

I. General information

NPI: 1104244581
Provider Name (Legal Business Name): EVELYN CORRALES VARGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 73RD ST # 69
SOUTH MIAMI FL
33143-4679
US

IV. Provider business mailing address

6200 SW 73RD ST # 69
SOUTH MIAMI FL
33143-4679
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-5465
  • Fax: 786-533-9246
Mailing address:
  • Phone: 786-662-5465
  • Fax: 786-533-9246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME133382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: