Healthcare Provider Details

I. General information

NPI: 1013195700
Provider Name (Legal Business Name): SIXTO G. VARGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 EVERHART RD SUITE 104B
CORPUS CHRISTI TX
78411-3949
US

IV. Provider business mailing address

PO BOX 6942
CORPUS CHRISTI TX
78466-6942
US

V. Phone/Fax

Practice location:
  • Phone: 361-852-0614
  • Fax: 361-852-0046
Mailing address:
  • Phone: 361-852-0614
  • Fax: 361-852-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number470
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number470
License Number StateTX

VIII. Authorized Official

Name: MR. SIXTO G VARGAS JR.
Title or Position: OWNER
Credential: CO, LO
Phone: 361-852-0614