Provider Demographics
NPI:1134847932
Name:VARGAS, VANESSA (MDS, RDN, LD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MDS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 AVENUE A APT 1117
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1272
Mailing Address - Country:US
Mailing Address - Phone:210-872-5176
Mailing Address - Fax:
Practice Address - Street 1:503 AVENUE A APT 1117
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1272
Practice Address - Country:US
Practice Address - Phone:210-872-5176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered