Healthcare Provider Details

I. General information

NPI: 1225414675
Provider Name (Legal Business Name): ROCHELLE-NOREEN VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2015
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 NIELSON RD
PHELAN CA
92371-8896
US

IV. Provider business mailing address

4075 NIELSON RD
PHELAN CA
92371-8896
US

V. Phone/Fax

Practice location:
  • Phone: 760-868-5817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP33737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: