Provider Demographics
NPI:1457701435
Name:VARGAS, JACQUELINE M (DS)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1416
Mailing Address - Country:US
Mailing Address - Phone:508-234-1332
Mailing Address - Fax:
Practice Address - Street 1:68 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1416
Practice Address - Country:US
Practice Address - Phone:508-234-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1881722437-110031460Medicaid