Provider Demographics
NPI:1013967900
Name:VARGAS-ARAYA, WESLEY LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:LUIS
Last Name:VARGAS-ARAYA
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:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0210
Mailing Address - Country:US
Mailing Address - Phone:505-464-4441
Mailing Address - Fax:505-464-4422
Practice Address - Street 1:318 ABALONE LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340
Practice Address - Country:US
Practice Address - Phone:505-464-4441
Practice Address - Fax:505-464-4422
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH2347Medicaid
NM320058Medicare PIN
NMH2347Medicaid