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General NPI Number Information
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NPI Number | 1013195700
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Entity Type | Organization
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Legal Business Name | SIXTO G. VARGAS
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 4949 EVERHART RD SUITE 104B
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-3949
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Country | US
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Telephone | 361-852-0614
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Fax | 361-852-0046
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Provider Business Mailing Address
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Address Line | PO BOX 6942
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City | CORPUS CHRISTI
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State | TX
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Zip | 78466-6942
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Country | US
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Telephone | 361-852-0614
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Fax | 361-852-0046
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Authorized Official
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Title or Position | OWNER
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Name | MR. SIXTO G VARGAS JR.
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Credential | CO, LO
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Telephone | 361-852-0614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 470
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 470
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License Number State | TX
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