Provider Demographics
NPI:1407059314
Name:ALEXANDER D VARGAS M D F A C S INC
Entity Type:Organization
Organization Name:ALEXANDER D VARGAS M D F A C S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:D
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-869-4567
Mailing Address - Street 1:11480 BROOKSHIRE AVENUE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5008
Mailing Address - Country:US
Mailing Address - Phone:562-869-4567
Mailing Address - Fax:562-869-4560
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5018
Practice Address - Country:US
Practice Address - Phone:562-869-4567
Practice Address - Fax:562-869-4560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXANDER D VARGAS M D F A C S INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26208208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262081Medicaid
CA00A262081Medicaid
CA0252450002Medicare NSC
CAA26208AMedicare PIN
CAA83343Medicare UPIN