Provider Demographics
NPI:1518909142
Name:VARGO-KITE, AMY MICHELLE (AUD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:VARGO-KITE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:VARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:FILE #55745
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-5745
Mailing Address - Country:US
Mailing Address - Phone:714-579-0717
Mailing Address - Fax:714-579-7827
Practice Address - Street 1:17021 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3743
Practice Address - Country:US
Practice Address - Phone:714-579-0717
Practice Address - Fax:714-579-7827
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2096231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWAU2096AMedicare PIN
CAWAU2096CMedicare PIN
CAWAU2096BMedicare PIN