Provider Demographics
NPI:1821737396
Name:FERNANDEZ-VARGAS, DIEGO DANIEL
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:DANIEL
Last Name:FERNANDEZ-VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E 16TH ST APT 12E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3507
Mailing Address - Country:US
Mailing Address - Phone:833-646-3222
Mailing Address - Fax:
Practice Address - Street 1:8507 CULEBRA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4810
Practice Address - Country:US
Practice Address - Phone:833-646-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician