Provider Demographics
NPI:1477274173
Name:VARGAS GONZALES, GLORIA L (NC 60700770)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:L
Last Name:VARGAS GONZALES
Suffix:
Gender:F
Credentials:NC 60700770
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3093
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-3093
Mailing Address - Country:US
Mailing Address - Phone:425-439-8852
Mailing Address - Fax:
Practice Address - Street 1:1400 N LAVENTURE RD
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-542-8801
Practice Address - Fax:360-542-8903
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60700770163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator