MEDICARE: DANIELA NOEMI MARTIR VARGAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1487276838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA NOEMI MARTIR VARGAS

Provider Business Mailing Address
First Line	:	PO BOX 100277
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0277
Country	:	US
Telephone Number	:	352-265-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 SW ARCHER RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-7004
Country	:	US
Telephone Number	:	352-265-7303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	03/24/2022

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