Provider Demographics
NPI:1750809877
Name:VARGAS, ABRAHAM ISRAEL
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:ISRAEL
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 1:201 BALCERZAK DR APT 7
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6303
Mailing Address - Country:US
Mailing Address - Phone:414-397-1202
Mailing Address - Fax:
Practice Address - Street 1:201 BALCERZAK DR.
Practice Address - Street 2:APT. 7
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:56001-6303
Practice Address - Country:US
Practice Address - Phone:414-397-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program