=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346600574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR MIGUELINA VARGAS, PHD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2016
-----------------------------------------------------
Last Update Date | 03/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1304 N ACADEMY BLVD SUITE 204
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80909-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-205-4309
-----------------------------------------------------
Fax | 719-465-3576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1304 N ACADEMY BLVD SUITE 204
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80909-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-205-4309
-----------------------------------------------------
Fax | 719-465-3576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. MIGUELINA VARGAS VARGAS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 719-205-4309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2647
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------