1447656467 NPI number — GABRIEL ROMANO VARGAS

Table of content: GABRIEL ROMANO VARGAS (NPI 1447656467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447656467 NPI number — GABRIEL ROMANO VARGAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGAS
Provider First Name:
GABRIEL
Provider Middle Name:
ROMANO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VARGAS
Provider Other First Name:
GABRIEL
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447656467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 VIRGINIA AVE NW
Provider Second Line Business Mailing Address:
APT E-615
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20037-2679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-276-8901
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 MACARTHUR BLVD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-244-6200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2014

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: 174400000X , with the licence number:  PT871730 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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