Healthcare Provider Details

I. General information

NPI: 1447902606
Provider Name (Legal Business Name): MARIA VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 W HORIZON RIDGE PKWY APT 120
HENDERSON NV
89052-5645
US

IV. Provider business mailing address

2570 W HORIZON RIDGE PKWY APT 120
HENDERSON NV
89052-5645
US

V. Phone/Fax

Practice location:
  • Phone: 562-306-3015
  • Fax:
Mailing address:
  • Phone: 562-306-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: