Provider Demographics
NPI:1104234160
Name:VARGAS, CELESTINO IV (COTA/L)
Entity type:Individual
Prefix:MR
First Name:CELESTINO
Middle Name:
Last Name:VARGAS
Suffix:IV
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 W VIA DEL SANTO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3426
Mailing Address - Country:US
Mailing Address - Phone:520-780-6350
Mailing Address - Fax:
Practice Address - Street 1:2848 W VIA DEL SANTO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3426
Practice Address - Country:US
Practice Address - Phone:520-780-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4903224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant