Provider Demographics
NPI:1538677984
Name:GONZALEZ VARGAS, JULIO CESAR
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:GONZALEZ VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 E CHARLESTON BLVD APT 17
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6455
Mailing Address - Country:US
Mailing Address - Phone:702-980-7837
Mailing Address - Fax:
Practice Address - Street 1:4870 E CHARLESTON BLVD APT 17
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6455
Practice Address - Country:US
Practice Address - Phone:702-980-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2105485364OtherIDENTIFICATION CARD