Provider Demographics
NPI:1083070627
Name:VARGAS-MASSARI, LUIS ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANGEL
Last Name:VARGAS-MASSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:1931 S NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7211
Practice Address - Country:US
Practice Address - Phone:407-986-9642
Practice Address - Fax:407-593-6102
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19948208D00000X
FLACN1420208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice