Provider Demographics
NPI:1770207375
Name:TENA-VARGAS, CRISTOPHER EDUARDO
Entity type:Individual
Prefix:
First Name:CRISTOPHER
Middle Name:EDUARDO
Last Name:TENA-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 1:620 S 400 E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3700
Mailing Address - Country:US
Mailing Address - Phone:435-656-8918
Mailing Address - Fax:
Practice Address - Street 1:620 S 400 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3700
Practice Address - Country:US
Practice Address - Phone:345-656-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128861583503101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)