Healthcare Provider Details

I. General information

NPI: 1215855564
Provider Name (Legal Business Name): IRMA VERGARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 COMMERCIAL ST APT 108
SAN DIEGO CA
92113-1190
US

IV. Provider business mailing address

2325 COMMERCIAL STREET APT#108
SAN DIEGO CA
92113
US

V. Phone/Fax

Practice location:
  • Phone: 619-791-8782
  • Fax:
Mailing address:
  • Phone: 619-791-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: