Provider Demographics
NPI:1316535115
Name:VARGAS-BOTEO, JONATHAN ROLANDO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROLANDO
Last Name:VARGAS-BOTEO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 PALO ALTO CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5435
Mailing Address - Country:US
Mailing Address - Phone:760-596-9181
Mailing Address - Fax:
Practice Address - Street 1:15940 QUANTICO RD STE 100
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1300
Practice Address - Country:US
Practice Address - Phone:760-946-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist