Provider Demographics
NPI:1326348301
Name:VARGAS, LESLIE E (AA)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:E
Last Name:VARGAS
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 BLUE SAGE AVE SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6616
Mailing Address - Country:US
Mailing Address - Phone:505-225-5240
Mailing Address - Fax:
Practice Address - Street 1:631 BLUE SAGE AVE SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6616
Practice Address - Country:US
Practice Address - Phone:505-225-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor