Provider Demographics
NPI:1730501057
Name:VARGAS VILUGRON, MARISOL ADA
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:ADA
Last Name:VARGAS VILUGRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1608
Mailing Address - Country:US
Mailing Address - Phone:214-828-1745
Mailing Address - Fax:214-352-0871
Practice Address - Street 1:4001 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1608
Practice Address - Country:US
Practice Address - Phone:214-828-1745
Practice Address - Fax:214-352-0871
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TX618681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker