Provider Demographics
NPI:1316296221
Name:VARGAS, SANDRA MILENA (MS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MILENA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 WESTWOOD DRIVE
Mailing Address - Street 2:APT 36
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-793-2651
Mailing Address - Fax:
Practice Address - Street 1:9909 WESTWOOD DRIVE
Practice Address - Street 2:APT 36
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-793-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor