Provider Demographics
NPI:1538218102
Name:VARGAS, JUAN DANIEL (LSA, CSA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:DANIEL
Last Name:VARGAS
Suffix:
Gender:M
Credentials:LSA, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 RESEARCH FOREST DR
Mailing Address - Street 2:SUITE 180-223
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4912
Mailing Address - Country:US
Mailing Address - Phone:281-419-1857
Mailing Address - Fax:281-419-1857
Practice Address - Street 1:26 E LOFTWOOD CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1496
Practice Address - Country:US
Practice Address - Phone:281-419-1857
Practice Address - Fax:281-419-1857
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00326246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant