Healthcare Provider Details

I. General information

NPI: 1245175488
Provider Name (Legal Business Name): BETTY TOLEDO VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SAINT JAMES AVE
LEE MA
01238-1108
US

IV. Provider business mailing address

30 SAINT JAMES AVE
LEE MA
01238-1108
US

V. Phone/Fax

Practice location:
  • Phone: 413-207-4697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA59075
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: