Healthcare Provider Details

I. General information

NPI: 1902729742
Provider Name (Legal Business Name): DANIRA MAZZOCCO VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 MCHENRY AVE STE C
MODESTO CA
95350-3264
US

IV. Provider business mailing address

3816 LORENE CT
MODESTO CA
95356-0828
US

V. Phone/Fax

Practice location:
  • Phone: 209-435-9550
  • Fax:
Mailing address:
  • Phone: 209-681-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: