Provider Demographics
NPI:1518692243
Name:GEORGE E. VARGAS MD LLC
Entity Type:Organization
Organization Name:GEORGE E. VARGAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:REANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMKHELAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-604-9595
Mailing Address - Street 1:17901 NW 105TH STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-538-0022
Mailing Address - Fax:954-538-0028
Practice Address - Street 1:17901 NW 5TH ST STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-538-0022
Practice Address - Fax:954-538-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty