1093213548 NPI number — NAOMI VARGAS LSWAIC

Table of content: NAOMI VARGAS LSWAIC (NPI 1093213548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093213548 NPI number — NAOMI VARGAS LSWAIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGAS
Provider First Name:
NAOMI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSWAIC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESPULGAR
Provider Other First Name:
NAOMI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093213548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7605 ALICE CT SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-639-3789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 182ND AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LAKE TAPPS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-501-6300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2018

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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