Provider Demographics
NPI:1093965477
Name:VARGAS-VELASCO, JOANNE CANIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:CANIO
Last Name:VARGAS-VELASCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:CANIO
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:12580 RAGWEED STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129
Mailing Address - Country:US
Mailing Address - Phone:858-335-6870
Mailing Address - Fax:
Practice Address - Street 1:12580 RAGWEED STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129
Practice Address - Country:US
Practice Address - Phone:858-335-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice