Healthcare Provider Details

I. General information

NPI: 1033154778
Provider Name (Legal Business Name): DAVID F. VARGAS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15982 QUANTICO RD
APPLE VALLEY CA
92307-1382
US

IV. Provider business mailing address

15982 QUANTICO RD
APPLE VALLEY CA
92307-1382
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2361
  • Fax: 760-242-1666
Mailing address:
  • Phone: 760-242-2361
  • Fax: 760-242-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberG175010
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID FLETCHER VARGAS
Title or Position: DOCTOR
Credential: M.D.
Phone: 760-242-2361