Provider Demographics
NPI:1033536214
Name:VARGAS, ANDREW GABRIEL
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GABRIEL
Last Name:VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 LAS VEGAS BLVD N
Mailing Address - Street 2:B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1555
Mailing Address - Country:US
Mailing Address - Phone:702-776-8397
Mailing Address - Fax:
Practice Address - Street 1:3636 LAS VEGAS BLVD N
Practice Address - Street 2:B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1555
Practice Address - Country:US
Practice Address - Phone:702-776-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health