Provider Demographics
NPI:1114178175
Name:VARGAS, MICHELE (LOMOT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LOMOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 GALT OCEAN OR
Mailing Address - Street 2:#1208
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:917-755-3206
Mailing Address - Fax:
Practice Address - Street 1:570 OCEAN DR
Practice Address - Street 2:#501
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA53843OtherLMT