MEDICARE: MARISA VARGAS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	42927	CA

General Provider Information

NPI Number	:	1033587043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA VARGAS PT

Provider Business Mailing Address
First Line	:	12123 GERBER AVE
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-1131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	537A E VINE AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-5102
Country	:	US
Telephone Number	:	888-763-4963
Fax Number	:	866-521-3578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	09/08/2015

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