Provider Demographics
NPI:1164840567
Name:RONALDO C. VARGAS D.D.S. INC.
Entity Type:Organization
Organization Name:RONALDO C. VARGAS D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:CAGUIA
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-670-0919
Mailing Address - Street 1:6875 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3231
Mailing Address - Country:US
Mailing Address - Phone:714-670-0919
Mailing Address - Fax:714-670-0870
Practice Address - Street 1:6875 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3231
Practice Address - Country:US
Practice Address - Phone:714-670-0919
Practice Address - Fax:714-670-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710020987OtherMEDI-CAL