Provider Demographics
NPI:1477796753
Name:VARGAS, SIXTO MANUEL (IDMT)
Entity Type:Individual
Prefix:MR
First Name:SIXTO
Middle Name:MANUEL
Last Name:VARGAS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:M
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDMT
Mailing Address - Street 1:PSC 80 BOX 17226
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0073
Mailing Address - Country:US
Mailing Address - Phone:315-634-6671
Mailing Address - Fax:
Practice Address - Street 1:PSC 80 BOX 17226
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367-0073
Practice Address - Country:US
Practice Address - Phone:315-634-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians