Healthcare Provider Details

I. General information

NPI: 1134623929
Provider Name (Legal Business Name): REMBERTO A VARGAS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 2ND AVE STE 506B
SILVER SPRING MD
20910-3362
US

IV. Provider business mailing address

8609 2ND AVE STE 506B
SILVER SPRING MD
20910-3362
US

V. Phone/Fax

Practice location:
  • Phone: 240-398-3514
  • Fax: 877-637-7490
Mailing address:
  • Phone: 240-398-3514
  • Fax: 877-637-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: