Provider Demographics
NPI:1821200205
Name:VARGAS, ANNA FERRIS (MS)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:FERRIS
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MOUNTAIN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-9490
Mailing Address - Country:US
Mailing Address - Phone:505-286-6108
Mailing Address - Fax:505-286-6108
Practice Address - Street 1:1405 MOUNTAIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-9490
Practice Address - Country:US
Practice Address - Phone:505-286-6108
Practice Address - Fax:505-286-6108
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist