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General NPI Number Information
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NPI Number | 1851896559
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Entity Type | Individual
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Provider Name | GUIDO S VERGARA FNP
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Gender | Male
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 7211 VAN NUYS BLVD
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City | VAN NUYS
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State | CA
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Zip | 91405-2256
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Country | US
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Telephone | 818-988-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 WATSEKA AVE APT 11
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City | LOS ANGELES
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State | CA
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Zip | 90034-3925
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Country | US
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Telephone | 310-986-0191
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 95006245
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License Number State | CA
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