Provider Demographics
NPI:1073570248
Name:ALARCON-VARGAS, BERTHA OLIVIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERTHA
Middle Name:OLIVIA
Last Name:ALARCON-VARGAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4566 FLORENCE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4345
Mailing Address - Country:US
Mailing Address - Phone:323-560-7474
Mailing Address - Fax:323-560-0424
Practice Address - Street 1:4566 FLORENCE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-4345
Practice Address - Country:US
Practice Address - Phone:323-560-7474
Practice Address - Fax:323-560-0424
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-29
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382451223G0001X
NV4835T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38245-01Medicaid