Healthcare Provider Details

I. General information

NPI: 1013967900
Provider Name (Legal Business Name): WESLEY LUIS VARGAS-ARAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 ABALONE LOOP
MESCALERO NM
88340
US

IV. Provider business mailing address

PO BOX 210
MESCALERO NM
88340-0210
US

V. Phone/Fax

Practice location:
  • Phone: 505-464-4441
  • Fax: 505-464-4422
Mailing address:
  • Phone: 505-464-4441
  • Fax: 505-464-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31501
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: