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General NPI Number Information
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NPI Number | 1306135751
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Entity Type | Individual
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Provider Name | VANESSA ILIANA VARGAS
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Gender | Female
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 12276 SAN JOSE BLVE SUITE 508
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City | JACKSONVILEL
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State | FL
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Zip | 32222-8618
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Country | US
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Telephone | 904-886-3228
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Fax | 904-404-7743
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Provider Business Mailing Address
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Address Line | 19075 SOMERSET RD UNIT 1
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City | LYTLE
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State | TX
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Zip | 78052-4111
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Country | US
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Telephone | 210-518-8103
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 115150
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License Number State | TX
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