Provider Demographics
NPI:1336462233
Name:VARGAS, DIANA (WHNP, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:WHNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-4145
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:212-690-0303
Mailing Address - Fax:
Practice Address - Street 1:2771 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3027
Practice Address - Country:US
Practice Address - Phone:212-690-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420615363LW0102X, 363L00000X
NY342448163WM0102X
NY142904163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner