MEDICARE: MELVIN ROBERTO VARGAS JR.

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1699475970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN ROBERTO VARGAS JR.

Provider Business Mailing Address
First Line	:	42654 32ND ST W
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-4032
Country	:	US
Telephone Number	:	661-522-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	42654 32ND ST W
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-4032
Country	:	US
Telephone Number	:	661-522-1449
Fax Number	:

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

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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