Provider Demographics
NPI:1598555088
Name:VERGARA, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VERGARA
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 1:500 CENTRAL PARK DR APT 706
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1731
Mailing Address - Country:US
Mailing Address - Phone:940-580-5305
Mailing Address - Fax:
Practice Address - Street 1:500 CENTRAL PARK DR APT 706
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1731
Practice Address - Country:US
Practice Address - Phone:940-580-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist