Provider Demographics
NPI:1104621713
Name:VARGAS, JUAN S
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:S
Last Name:VARGAS
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 1:8771 DAWSON ST APT 202
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4984
Mailing Address - Country:US
Mailing Address - Phone:720-936-7257
Mailing Address - Fax:
Practice Address - Street 1:8771 DAWSON ST APT 202
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80229-4984
Practice Address - Country:US
Practice Address - Phone:720-936-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program