Provider Demographics
NPI:1689299877
Name:VARGO, ZACHARY ADAM (IDC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:ADAM
Last Name:VARGO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 GILL VILLAGE WAY APT 1113
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5580
Mailing Address - Country:US
Mailing Address - Phone:904-651-9949
Mailing Address - Fax:
Practice Address - Street 1:2266 GILL VILLAGE WAY APT 1113
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5580
Practice Address - Country:US
Practice Address - Phone:904-651-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman