Provider Demographics
NPI:1578753059
Name:VARGAS, JEAN DANIEL (HEALTH SERVICES TECH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:DANIEL
Last Name:VARGAS
Suffix:
Gender:M
Credentials:HEALTH SERVICES TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2442
Mailing Address - Country:US
Mailing Address - Phone:512-638-2891
Mailing Address - Fax:
Practice Address - Street 1:104 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2442
Practice Address - Country:US
Practice Address - Phone:512-638-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic