Healthcare Provider Details

I. General information

NPI: 1154670065
Provider Name (Legal Business Name): VIRIDIANA VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 W GARVEY AVE N
WEST COVINA CA
91790-2138
US

IV. Provider business mailing address

4860 STANCROFT AVE
BALDWIN PARK CA
91706-1932
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-5027
  • Fax: 626-294-1079
Mailing address:
  • Phone: 626-856-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: