Provider Demographics
NPI:1629060694
Name:VARGA, CLAYTON ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:ALEXANDER
Last Name:VARGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE 50475
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0475
Mailing Address - Country:US
Mailing Address - Phone:626-403-6200
Mailing Address - Fax:626-403-2968
Practice Address - Street 1:1017 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2621
Practice Address - Country:US
Practice Address - Phone:626-403-6200
Practice Address - Fax:626-403-2968
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52859207LP2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52859OtherMEDICAL LICENSE
CA00G528590Medicaid
CAWG52859EMedicare PIN
CAG52859OtherMEDICAL LICENSE