Provider Demographics
NPI:1073302659
Name:VARGAS-MENDOZA, MARY ANN (NBCMI)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:VARGAS-MENDOZA
Suffix:
Gender:
Credentials:NBCMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GREW HILL RD APT 1
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4910
Mailing Address - Country:US
Mailing Address - Phone:413-214-4030
Mailing Address - Fax:
Practice Address - Street 1:55 GREW HILL RD APT 1
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4910
Practice Address - Country:US
Practice Address - Phone:413-214-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100579171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter