Healthcare Provider Details

I. General information

NPI: 1366838948
Provider Name (Legal Business Name): MANUEL VARGAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE # T4M2
NEW ORLEANS LA
70112-2865
US

IV. Provider business mailing address

4422 LAKE VISTA DR
METAIRIE LA
70006-2106
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4498
  • Fax:
Mailing address:
  • Phone: 815-641-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number303026
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number303026
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: