Provider Demographics
NPI:1376376095
Name:VARGAS SALAS, MANUEL ADRIAN
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ADRIAN
Last Name:VARGAS SALAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-7308
Mailing Address - Country:US
Mailing Address - Phone:720-277-4105
Mailing Address - Fax:
Practice Address - Street 1:4 BURNS WAY
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-7308
Practice Address - Country:US
Practice Address - Phone:720-277-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist