Healthcare Provider Details

I. General information

NPI: 1306873583
Provider Name (Legal Business Name): MICHELE T VARGAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S GRAND AVE
GLENDORA CA
91741-4218
US

IV. Provider business mailing address

2208 RIM RD
DUARTE CA
91010-1237
US

V. Phone/Fax

Practice location:
  • Phone: 626-857-3170
  • Fax:
Mailing address:
  • Phone: 626-848-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A7256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: