Provider Demographics
NPI:1932699295
Name:VARGAS, ELIZABETH RODRIGUEZ (SA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RODRIGUEZ
Last Name:VARGAS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 BENT TREE FOREST CIR APT 1093
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3402
Mailing Address - Country:US
Mailing Address - Phone:214-875-0773
Mailing Address - Fax:
Practice Address - Street 1:15905 BENT TREE FOREST CIR APT 1093
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3402
Practice Address - Country:US
Practice Address - Phone:214-875-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17-632246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant