Provider Demographics
NPI:1689294118
Name:VERGARA, YOLANDA SALAS (DRT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:SALAS
Last Name:VERGARA
Suffix:
Gender:F
Credentials:DRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13440 SUNNYVIEW TRAILS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253
Mailing Address - Country:US
Mailing Address - Phone:210-378-9640
Mailing Address - Fax:
Practice Address - Street 1:215 E QUINCY ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2032
Practice Address - Country:US
Practice Address - Phone:210-378-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology