Basic Information
| Provider Information | |||||||||
| NPI: | 1629275797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VARGAS,FRANK M.D. PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19022 NE 29TH AVE | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331802823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057920855 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19022 NE 29TH AVE | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331802823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057920855 | ||||||||
| FaxNumber: | 3059361022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FRANK | ||||||||
| AuthorizedOfficialFirstName: | SHELDON | ||||||||
| AuthorizedOfficialMiddleName: | MICHEAL | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3057920855 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 10827 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |