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General NPI Number Information
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NPI Number | 1255456620
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Entity Type | Individual
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Provider Name | TRACI RENEE VARGAS NP
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 10418 VALLEY BLVD
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City | EL MONTE
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State | CA
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Zip | 91731-3600
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Country | US
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Telephone | 626-453-8466
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Fax | 626-453-8465
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Provider Business Mailing Address
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Address Line | 10418 VALLEY BLVD
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City | EL MONTE
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State | CA
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Zip | 91731-3600
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Country | US
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Telephone | 626-453-8466
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Fax | 626-453-8465
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 462956
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 16153
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License Number State | CA
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