Provider Demographics
NPI:1770087306
Name:VARGAS, CYNTHIA MAYE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MAYE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SHADY HILL DR APT 22A
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3623
Mailing Address - Country:US
Mailing Address - Phone:832-629-7409
Mailing Address - Fax:
Practice Address - Street 1:3400 SHADY HILL DR APT 22A
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3623
Practice Address - Country:US
Practice Address - Phone:832-629-7409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14324954Medicaid