Basic Information
| Provider Information | |||||||||
| NPI: | 1821229279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGAS VILLAZON | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 997 W KINGSLEY DR | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836466465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133587941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1512 12TH AVE RD | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836866008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084635000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2009 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 240133 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RA0000X | M-11976 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
No ID Information.