Healthcare Provider Details

I. General information

NPI: 1982915468
Provider Name (Legal Business Name): LAURA C VARGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE FAMILY MEDICINE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE FAMILY MEDICINE
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-2673
  • Fax: 909-427-5219
Mailing address:
  • Phone: 909-427-2673
  • Fax: 909-427-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA124287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: