Healthcare Provider Details

I. General information

NPI: 1336282391
Provider Name (Legal Business Name): SOLON VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 GLACIER DR
MARTINEZ CA
94553-4826
US

IV. Provider business mailing address

1459 WHARTON WAY APT F
CONCORD CA
94521-2969
US

V. Phone/Fax

Practice location:
  • Phone: 925-957-2757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number622839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: