Healthcare Provider Details

I. General information

NPI: 1619450251
Provider Name (Legal Business Name): MR. JORGE J VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9507 LETTERSTONE CT
TAMPA FL
33615-1972
US

IV. Provider business mailing address

9507 LETTERSTONE CT
TAMPA FL
33615-1972
US

V. Phone/Fax

Practice location:
  • Phone: 813-385-4860
  • Fax:
Mailing address:
  • Phone: 813-385-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: