Provider Demographics
NPI:1215527189
Name:VARGAS-SANTOS, JUAN RAMON
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:RAMON
Last Name:VARGAS-SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13260 JOSEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-4979
Mailing Address - Country:US
Mailing Address - Phone:972-247-3421
Mailing Address - Fax:
Practice Address - Street 1:13260 JOSEY LN STE 100
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4979
Practice Address - Country:US
Practice Address - Phone:972-247-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155203183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician