Provider Demographics
NPI:1164643805
Name:VARGAS-MIRABAL, YIDRISCA MARIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YIDRISCA
Middle Name:MARIA
Last Name:VARGAS-MIRABAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:YIDRISCA
Other - Middle Name:MARIA
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-0545
Mailing Address - Fax:717-544-0546
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 310
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-0545
Practice Address - Fax:717-544-0546
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052925363AM0700X
PAOA002249363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50071216OtherCAPITAL BLUE CROSS
PA642308OtherHEALTH AMERICA
PA642308OtherHEALTH AMERICA