Healthcare Provider Details

I. General information

NPI: 1356204929
Provider Name (Legal Business Name): ANTHONY RAY RAY VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A10S
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

1000 S FREMONT AVE BLDG A10S
ALHAMBRA CA
91803-8800
US

V. Phone/Fax

Practice location:
  • Phone: 626-349-3838
  • Fax: 855-838-9042
Mailing address:
  • Phone: 626-349-3838
  • Fax: 855-838-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: