Provider Demographics
NPI:1790716678
Name:HOLKON-VARGAS, LUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:HOLKON-VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 NW 177 STREET
Mailing Address - Street 2:UNIT 203
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015
Mailing Address - Country:US
Mailing Address - Phone:786-333-7210
Mailing Address - Fax:
Practice Address - Street 1:7100 NW 177 STREET
Practice Address - Street 2:UNIT 203
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:786-333-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG05858Medicare UPIN
FL26674Medicare PIN