Individual
MR. JUAN PABLO VARGAS FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
269 S CANDY LN, COTTONWOOD, AZ 86326-4170
(928) 634-2251
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
65408
AZ
208M00000X
Hospitalist Physician
Primary
65408
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2019
Last updated
03/18/2025
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