Provider Demographics
NPI:1356523419
Name:VARGAS, MARIA ELENA (LMP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90601 W HANKS RD
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-8617
Mailing Address - Country:US
Mailing Address - Phone:509-973-3180
Mailing Address - Fax:509-973-2210
Practice Address - Street 1:90601 W HANKS RD
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-8617
Practice Address - Country:US
Practice Address - Phone:509-973-3180
Practice Address - Fax:509-973-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist