1437137353 NPI number — DR. CHARLENE VARGAS MD

Table of content: DR. CHARLENE VARGAS MD (NPI 1437137353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437137353 NPI number — DR. CHARLENE VARGAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGAS
Provider First Name:
CHARLENE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRANDA
Provider Other First Name:
CHARLENE
Provider Other Middle Name:
FRANI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437137353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1653 JESS PARRISH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TITUSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32796-2145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-267-5965
Provider Business Mailing Address Fax Number:
321-267-8487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1653 JESS PARRISH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TITUSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32796-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-267-5965
Provider Business Practice Location Address Fax Number:
321-267-8487
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  ME100513 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 280554500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123067 . This is a "NATIONWIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8495401 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1205165 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000392792 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2536509 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7937577 . This is a "ETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100622800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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