Provider Demographics
NPI:1225054513
Name:DE VARGAS, CECILIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:C
Last Name:DE VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2702
Mailing Address - Country:US
Mailing Address - Phone:915-215-5871
Mailing Address - Fax:915-545-6442
Practice Address - Street 1:4615 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2702
Practice Address - Country:US
Practice Address - Phone:915-215-5871
Practice Address - Fax:915-545-6442
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF22192084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123774504Medicaid
TX89112JMedicare ID - Type Unspecified
TXB22161Medicare UPIN