Individual
JESUS VARGAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
901 N CURTIS RD STE 204, BOISE, ID 83706-1340
(208) 367-3315
Mailing address
3416 W MEADOW DR, BOISE, ID 83706-2739
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-662
ID
Other
Enumeration date
10/11/2018
Last updated
10/11/2018
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