Provider Demographics
NPI:1457632077
Name:VARGAS, GEORGE
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:VARGAS
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 1:202 CENTRAL AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3459
Mailing Address - Country:US
Mailing Address - Phone:505-268-1125
Mailing Address - Fax:505-268-1124
Practice Address - Street 1:202 CENTRAL AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3459
Practice Address - Country:US
Practice Address - Phone:505-268-1125
Practice Address - Fax:505-268-1124
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator