1558548727 NPI number — MRS. EMILIE LOUISE VARGAZ MPAS, PA-C

Table of content: MRS. EMILIE LOUISE VARGAZ MPAS, PA-C (NPI 1558548727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558548727 NPI number — MRS. EMILIE LOUISE VARGAZ MPAS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGAZ
Provider First Name:
EMILIE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPAS, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERBE
Provider Other First Name:
EMILIE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPAS, PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558548727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9494 W NORTHERN AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85305-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-872-2226
Provider Business Mailing Address Fax Number:
623-872-1018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9494 W NORTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85305-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-872-2226
Provider Business Practice Location Address Fax Number:
623-872-1018
Provider Enumeration Date:
01/29/2008

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: 363A00000X , with the licence number:  PA 19524 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 4182 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: AMD-361 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: AMD-361 . This is a "STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: PA 19524 . This is a "PHYSICIAN ASSIST COMMITTE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4182 . This is a "ARIZONA MEDICAL BOARD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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