1689127110 NPI number — KARINA MENDEZ VARGAS MD PA

Table of content: (NPI 1689127110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689127110 NPI number — KARINA MENDEZ VARGAS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARINA MENDEZ VARGAS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689127110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 GATEWAY WAY BLVD W
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79925-3315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-779-1716
Provider Business Mailing Address Fax Number:
915-771-6496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3270 JOE BATTLE BLVD
Provider Second Line Business Practice Location Address:
STE 195
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79938-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-206-2141
Provider Business Practice Location Address Fax Number:
915-206-2155
Provider Enumeration Date:
08/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ-VARGAS
Authorized Official First Name:
KARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
787-423-7883

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q7929 . This is a "TX LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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