Healthcare Provider Details

I. General information

NPI: 1518885854
Provider Name (Legal Business Name): MANUEL U VARGAS CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S 8TH ST
DEMING NM
88030-4903
US

IV. Provider business mailing address

1420 S 8TH ST
DEMING NM
88030-4903
US

V. Phone/Fax

Practice location:
  • Phone: 575-332-5521
  • Fax:
Mailing address:
  • Phone: 575-332-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2089
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: