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General NPI Number Information
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NPI Number | 1700240629
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Entity Type | Individual
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Provider Name | ANN SHERLY VARGHESE A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 401 E HIGHLAND AVE SUITE NO. 551
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3803
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Country | US
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Telephone | 909-475-0935
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Fax |
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Provider Business Mailing Address
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Address Line | 1553 W CERES ST
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City | RIALTO
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State | CA
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Zip | 92376-6279
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Country | US
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Telephone | 909-215-0803
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95004028
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License Number State | CA
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