Provider Demographics
NPI:1083427397
Name:VARGAS VIZCAYA, ROBERT EDGARDO
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDGARDO
Last Name:VARGAS VIZCAYA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3530
Mailing Address - Country:US
Mailing Address - Phone:614-928-0409
Mailing Address - Fax:
Practice Address - Street 1:5601 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3530
Practice Address - Country:US
Practice Address - Phone:614-928-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000746246ZC0007X
363AS0400X
DCSA2000005246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant