Provider Demographics
NPI:1780883108
Name:YARA VARGAS MD PLC
Entity type:Organization
Organization Name:YARA VARGAS MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REAJ
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-214-6154
Mailing Address - Street 1:2919 S ELLSWORTH RD STE 117
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2166
Mailing Address - Country:US
Mailing Address - Phone:480-365-0557
Mailing Address - Fax:480-365-0996
Practice Address - Street 1:2919 S ELLSWORTH RD STE 117
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2166
Practice Address - Country:US
Practice Address - Phone:480-365-0557
Practice Address - Fax:480-365-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33846261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ946329Medicaid
I37322Medicare UPIN