Provider Demographics
NPI:1619970191
Name:VARGAS, ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 BURKE RD
Mailing Address - Street 2:STE 202
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1823
Mailing Address - Country:US
Mailing Address - Phone:713-946-9513
Mailing Address - Fax:713-946-7210
Practice Address - Street 1:3315 BURKE RD
Practice Address - Street 2:STE 202
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1823
Practice Address - Country:US
Practice Address - Phone:713-946-9513
Practice Address - Fax:713-946-7210
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02278363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP40460Medicare UPIN
TX8A5043Medicare ID - Type UnspecifiedMEDICARE