Provider Demographics
NPI:1578019816
Name:VARGAS, WILDALIZ (BS)
Entity Type:Individual
Prefix:
First Name:WILDALIZ
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S. ORANGE BLOSSOM TRAIL, SUITE 261
Mailing Address - Street 2:UNIT240
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3234
Mailing Address - Country:US
Mailing Address - Phone:407-270-6685
Mailing Address - Fax:
Practice Address - Street 1:260 S. ORANGE BLOSSOM TRAIL, SUITE 261
Practice Address - Street 2:UNIT240
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3234
Practice Address - Country:US
Practice Address - Phone:407-270-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling