Provider Demographics
NPI:1730282351
Name:VARGAS, MARILIN
Entity Type:Individual
Prefix:MRS
First Name:MARILIN
Middle Name:
Last Name:VARGAS
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 1:16745 SATICOY ST
Mailing Address - Street 2:#113
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:818-997-4023
Mailing Address - Fax:818-997-4025
Practice Address - Street 1:16745 SATICOY ST
Practice Address - Street 2:#113
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-997-4023
Practice Address - Fax:818-997-4025
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5328270001Medicare ID - Type Unspecified