Provider Demographics
NPI:1184365256
Name:VARGAS, YOLANDA (LMT)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1209 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1423
Mailing Address - Country:US
Mailing Address - Phone:509-786-3637
Mailing Address - Fax:509-786-7385
Practice Address - Street 1:1209 MEADE AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1423
Practice Address - Country:US
Practice Address - Phone:509-786-3637
Practice Address - Fax:509-786-7385
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWDL43172293BOtherDRIVER'S LICENSE