Provider Demographics
NPI:1447610555
Name:VARGO, JOANNE MARIE
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIE
Last Name:VARGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 SAN CARLOS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5242
Mailing Address - Country:US
Mailing Address - Phone:707-694-6588
Mailing Address - Fax:
Practice Address - Street 1:740 TEXAS ST
Practice Address - Street 2:STE 208
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5512
Practice Address - Country:US
Practice Address - Phone:707-389-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35000OtherCAMTC (CALIFORNIA MASSAGE THERAPY COUNCIL)