Provider Demographics
NPI:1750636601
Name:VARGAS, CARLOS FERNANDO
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:FERNANDO
Last Name:VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:FERNANDO
Other - Last Name:VARGAS-NUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 S FORT APACHE RD UNIT 2172
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-574-0250
Mailing Address - Fax:
Practice Address - Street 1:730 N EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2885
Practice Address - Country:US
Practice Address - Phone:702-772-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor