Provider Demographics
NPI:1942286778
Name:VARGAS, DIANA E (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:E
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10250 SW 56TH ST
Mailing Address - Street 2:STE. B-103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7069
Mailing Address - Country:US
Mailing Address - Phone:305-207-7333
Mailing Address - Fax:305-207-7444
Practice Address - Street 1:10250 SW 56TH ST
Practice Address - Street 2:STE. B-103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7069
Practice Address - Country:US
Practice Address - Phone:305-207-7333
Practice Address - Fax:305-207-7444
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0492972080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044584300Medicaid
FLD50573Medicare UPIN