Healthcare Provider Details

I. General information

NPI: 1992837892
Provider Name (Legal Business Name): MARIA XIMENA VARGAS JARAMILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD EMERGENCY DEPARTMENT
PASADENA CA
91105-3010
US

IV. Provider business mailing address

PO BOX 60259
LOS ANGELES CA
90060-0259
US

V. Phone/Fax

Practice location:
  • Phone: 626-347-7762
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA868961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: