Provider Demographics
NPI:1588994792
Name:VARGAS, AUGUSTO ENRIQUE (RT)
Entity type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:ENRIQUE
Last Name:VARGAS
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-2011
Mailing Address - Country:US
Mailing Address - Phone:973-777-6826
Mailing Address - Fax:
Practice Address - Street 1:72 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2011
Practice Address - Country:US
Practice Address - Phone:973-777-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6338992471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging