Healthcare Provider Details

I. General information

NPI: 1841447869
Provider Name (Legal Business Name): VICENTE VARGAS JR. RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CAMBRIDGE AVE
EL PASO TX
79903-1307
US

IV. Provider business mailing address

3920 CAMBRIDGE AVE
EL PASO TX
79903-1307
US

V. Phone/Fax

Practice location:
  • Phone: 915-565-2742
  • Fax:
Mailing address:
  • Phone: 915-565-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number335935
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: