Provider Demographics
NPI:1669654885
Name:VARGAS, CAROLYN JOANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:JOANN
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:JOANN
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23456 HAWTHORNE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4774
Mailing Address - Country:US
Mailing Address - Phone:310-791-5577
Mailing Address - Fax:310-791-5575
Practice Address - Street 1:23456 HAWTHORNE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4774
Practice Address - Country:US
Practice Address - Phone:310-791-5577
Practice Address - Fax:310-791-5575
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF9642Medicare UPIN