Provider Demographics
NPI:1497560452
Name:VARGAS, GENESIS GABRIELA
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:GABRIELA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 N 18TH DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3422
Mailing Address - Country:US
Mailing Address - Phone:509-581-8964
Mailing Address - Fax:
Practice Address - Street 1:1719 N 18TH DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3422
Practice Address - Country:US
Practice Address - Phone:509-581-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program