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General NPI Number Information
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NPI Number | 1285891754
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Entity Type | Individual
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Provider Name | MENCIA GOMEZ DE VARGAS MD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1946 TYLER ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4517
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Country | US
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Telephone | 754-227-3373
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Fax | 571-386-2627
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Provider Business Mailing Address
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Address Line | 1946 TYLER ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4517
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Country | US
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Telephone | 754-333-9815
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Fax | 571-386-2627
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | ME121955
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License Number State | FL
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