Provider Demographics
NPI:1275657199
Name:VARGAS, STELLA DEL ROCIO (PT)
Entity Type:Individual
Prefix:MS
First Name:STELLA
Middle Name:DEL ROCIO
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1538
Mailing Address - Country:US
Mailing Address - Phone:714-772-0678
Mailing Address - Fax:
Practice Address - Street 1:1535 DEERPARK DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2286
Practice Address - Country:US
Practice Address - Phone:714-993-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11894Medicare ID - Type Unspecified