Provider Demographics
NPI:1558548727
Name:VARGAZ, EMILIE LOUISE (MPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:LOUISE
Last Name:VARGAZ
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:MRS
Other - First Name:EMILIE
Other - Middle Name:LOUISE
Other - Last Name:ERBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:9494 W NORTHERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-1118
Mailing Address - Country:US
Mailing Address - Phone:623-872-2226
Mailing Address - Fax:623-872-1018
Practice Address - Street 1:9494 W NORTHERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-1118
Practice Address - Country:US
Practice Address - Phone:623-872-2226
Practice Address - Fax:623-872-1018
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19524363A00000X
AZ4182363A00000X
HIAMD-361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAMD-361OtherSTATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
CAPA 19524OtherPHYSICIAN ASSIST COMMITTE
AZ4182OtherARIZONA MEDICAL BOARD