=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629060694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLAYTON ALEXANDER VARGA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2005
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3434 MIDWAY DR STE 2001
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92110-4924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-325-1161
-----------------------------------------------------
Fax | 619-325-1717
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10565 CIVIC CENTER DR STE 250
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-3854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-696-1400
-----------------------------------------------------
Fax | 626-696-1451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | G52859
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------