Provider Demographics
NPI:1750890372
Name:VARGAS, GERSON
Entity type:Individual
Prefix:MR
First Name:GERSON
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 TROPICAL SANDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1167
Mailing Address - Country:US
Mailing Address - Phone:1702-838-3587
Mailing Address - Fax:
Practice Address - Street 1:7830 W ANN RD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-5605
Practice Address - Country:US
Practice Address - Phone:702-838-3587
Practice Address - Fax:702-838-3587
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist