Healthcare Provider Details

I. General information

NPI: 1922505775
Provider Name (Legal Business Name): CHRISTOPHER B VARGAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 FENTON ST STE C203
CHULA VISTA CA
91914-3599
US

IV. Provider business mailing address

PO BOX 210160
CHULA VISTA CA
91921-0160
US

V. Phone/Fax

Practice location:
  • Phone: 619-600-5309
  • Fax: 619-655-4700
Mailing address:
  • Phone: 619-600-5309
  • Fax: 619-655-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number55263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: