Provider Demographics
NPI:1346600574
Name:DR MIGUELINA VARGAS, PHD
Entity Type:Organization
Organization Name:DR MIGUELINA VARGAS, PHD
Other - Org Name:DR MIGUELINA J VARGAS PSYCHOLOGIST LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUELINA VARGAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-205-4309
Mailing Address - Street 1:1304 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3325
Mailing Address - Country:US
Mailing Address - Phone:719-205-4309
Mailing Address - Fax:719-465-3576
Practice Address - Street 1:1304 N ACADEMY BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3325
Practice Address - Country:US
Practice Address - Phone:719-205-4309
Practice Address - Fax:719-465-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2647103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO279008OtherPTAN
CO11421835Medicaid