Provider Demographics
NPI:1275047870
Name:VARGAS MARMOLEJOS, CAROLINA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:VARGAS MARMOLEJOS
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 1:550 N REO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1061
Mailing Address - Country:US
Mailing Address - Phone:813-374-2070
Mailing Address - Fax:813-337-0937
Practice Address - Street 1:550 N REO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1061
Practice Address - Country:US
Practice Address - Phone:813-374-2070
Practice Address - Fax:813-337-0937
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician