Provider Demographics
NPI:1548032345
Name:VARGAS, MONICA ANDREA (DACM, LAC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ANDREA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 N FEDERAL HWY APT 212
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1879
Mailing Address - Country:US
Mailing Address - Phone:201-637-2269
Mailing Address - Fax:
Practice Address - Street 1:890 N FEDERAL HWY APT 212
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1879
Practice Address - Country:US
Practice Address - Phone:201-637-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA4401133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education