Healthcare Provider Details

I. General information

NPI: 1891396446
Provider Name (Legal Business Name): CARLOS DANIEL VARGAS PAVIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. CARLOS DANIEL VARGAS

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

MSC 09 5040 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3414
  • Fax:
Mailing address:
  • Phone: 505-272-6607
  • Fax: 505-272-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2024-0644
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: