Provider Demographics
NPI:1235409301
Name:EDUARDO A. VERGARA M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EDUARDO A. VERGARA M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:408-294-1420
Mailing Address - Street 1:2039 FOREST AVE, 205-A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-294-1420
Mailing Address - Fax:408-213-0820
Practice Address - Street 1:2039 FOREST AVE, 205-A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-294-1420
Practice Address - Fax:408-213-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37907207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty