Provider Demographics
NPI:1326361726
Name:VARGAS, JUVENCIO (DC)
Entity Type:Individual
Prefix:DR
First Name:JUVENCIO
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3863
Mailing Address - Country:US
Mailing Address - Phone:530-662-6262
Mailing Address - Fax:530-662-6260
Practice Address - Street 1:181 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3863
Practice Address - Country:US
Practice Address - Phone:530-662-6262
Practice Address - Fax:530-662-6260
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor