Provider Demographics
NPI:1306135751
Name:VARGAS, VANESSA ILIANA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ILIANA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19075 SOMERSET RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-4111
Mailing Address - Country:US
Mailing Address - Phone:210-518-8103
Mailing Address - Fax:
Practice Address - Street 1:12276 SAN JOSE BLVE
Practice Address - Street 2:SUITE 508
Practice Address - City:JACKSONVILEL
Practice Address - State:FL
Practice Address - Zip Code:32222-8618
Practice Address - Country:US
Practice Address - Phone:904-886-3228
Practice Address - Fax:904-404-7743
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115150235Z00000X
FLSZ75262355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ7526OtherSPEECH LICENCE
TX35922OtherSTATE LICENSE