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General NPI Number Information
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NPI Number | 1992296545
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Entity Type | Individual
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Provider Name | ISAIAS RODOLFO VARGAS JR. CRNP
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Gender | Male
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 16850 BEAR VALLEY RD
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City | VICTORVILLE
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State | CA
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Zip | 92395-5795
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Country | US
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Telephone | 760-241-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1786
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91729-1786
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Country | US
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Telephone | 702-675-0557
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP018742
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP95011154
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License Number State | CA
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