Healthcare Provider Details

I. General information

NPI: 1710810650
Provider Name (Legal Business Name): AUDREY L VARGAS PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE BLDG B1
ALBUQUERQUE NM
87110-8903
US

IV. Provider business mailing address

3939 SAN PEDRO DR NE BLDG B1
ALBUQUERQUE NM
87110-8903
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-7600
  • Fax: 505-344-2104
Mailing address:
  • Phone: 505-440-7600
  • Fax: 505-344-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0715
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: