Healthcare Provider Details

I. General information

NPI: 1891718169
Provider Name (Legal Business Name): DAVID A VARGAS LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SIPAPU ROAD BOX 6952
TAOS NM
87571
US

IV. Provider business mailing address

PO BOX 1053
RANCHOS DE TAOS NM
87557
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-5857
  • Fax: 505-758-2832
Mailing address:
  • Phone: 505-758-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberB4403
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: