Provider Demographics
NPI:1861593246
Name:VARGAS, LISA MICHELLE GUERRA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE GUERRA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE GUERRA
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:333 N SANTA ROSA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:210-704-4100
Mailing Address - Fax:
Practice Address - Street 1:94 BRIGGS ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1206
Practice Address - Country:US
Practice Address - Phone:210-922-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75830208000000X
TXT3403208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics