Provider Demographics
NPI:1063805265
Name:DIANA E VARGAS MD
Entity type:Organization
Organization Name:DIANA E VARGAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-207-7333
Mailing Address - Street 1:10250 SW 56TH ST
Mailing Address - Street 2:SUITE B-103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7069
Mailing Address - Country:US
Mailing Address - Phone:305-207-7333
Mailing Address - Fax:305-207-7444
Practice Address - Street 1:10250 SW 56TH ST
Practice Address - Street 2:SUITE B-103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7069
Practice Address - Country:US
Practice Address - Phone:305-207-7333
Practice Address - Fax:305-207-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044584300Medicaid