Provider Demographics
NPI:1083039960
Name:VARGAS, GLORIA ELSA
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ELSA
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 1:10268 NW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2658
Mailing Address - Country:US
Mailing Address - Phone:305-599-0188
Mailing Address - Fax:305-513-0137
Practice Address - Street 1:10268 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2658
Practice Address - Country:US
Practice Address - Phone:305-599-0188
Practice Address - Fax:305-513-0137
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003562002080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics