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General NPI Number Information
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NPI Number | 1003849043
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Entity Type | Organization
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Legal Business Name | NILDA VERGARA M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 2039 FOREST AVE STE 205B
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City | SAN JOSE
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State | CA
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Zip | 95128-4815
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Country | US
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Telephone | 408-295-0211
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Fax | 408-297-9326
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Provider Business Mailing Address
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Address Line | 2039 FOREST AVE STE 205B
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City | SAN JOSE
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State | CA
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Zip | 95128-4815
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Country | US
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Telephone | 408-295-0211
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Fax | 408-297-9326
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NILDA VERGARA
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Credential | M.D.
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Telephone | 408-295-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A37908
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License Number State | CA
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