Provider Demographics
NPI:1417719428
Name:VARGAS VITALITY CENTER, LLC
Entity Type:Organization
Organization Name:VARGAS VITALITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-279-0295
Mailing Address - Street 1:931 N STATE ROAD 434 STE 1195
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7065
Mailing Address - Country:US
Mailing Address - Phone:321-279-0295
Mailing Address - Fax:321-326-1819
Practice Address - Street 1:931 N STATE ROAD 434 STE 1195
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7065
Practice Address - Country:US
Practice Address - Phone:321-279-0295
Practice Address - Fax:321-326-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty