Provider Demographics
NPI:1497264949
Name:GARGUREVICH, MILAGROS (PHD)
Entity type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:
Last Name:GARGUREVICH
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:MILAGROS
Other - Middle Name:
Other - Last Name:GARGUREVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7321 BALMER ST BLDG 545
Mailing Address - Street 2:
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5012
Mailing Address - Country:US
Mailing Address - Phone:801-777-7909
Mailing Address - Fax:
Practice Address - Street 1:7321 BALMER ST BLDG 545
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5012
Practice Address - Country:US
Practice Address - Phone:801-777-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA60939923103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program