Healthcare Provider Details

I. General information

NPI: 1710568266
Provider Name (Legal Business Name): JUANA TEODORA VARGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OCONNOR DR STE 250
SAN JOSE CA
95128-1644
US

IV. Provider business mailing address

455 OCONNOR DR STE 250
SAN JOSE CA
95128-1644
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-7666
  • Fax:
Mailing address:
  • Phone: 408-283-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA196919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: