Provider Demographics
NPI:1033790662
Name:VARGAS, CAMILA ALICIA
Entity Type:Individual
Prefix:
First Name:CAMILA
Middle Name:ALICIA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 STAFFORD GLEN CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1762
Mailing Address - Country:US
Mailing Address - Phone:703-597-4670
Mailing Address - Fax:
Practice Address - Street 1:14 N STAFFORD COMPLEX CTR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1901
Practice Address - Country:US
Practice Address - Phone:540-602-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230033200183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician