Healthcare Provider Details

I. General information

NPI: 1457394470
Provider Name (Legal Business Name): ISMAEL C. VARGAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 REITH WAY
SUNNYSIDE WA
98944-9521
US

IV. Provider business mailing address

2303 REITH WAY
SUNNYSIDE WA
98944-9521
US

V. Phone/Fax

Practice location:
  • Phone: 509-837-3933
  • Fax: 509-837-3885
Mailing address:
  • Phone: 509-837-3933
  • Fax: 509-837-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003746
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: