Provider Demographics
NPI:1740589118
Name:MATA-VARGAS, JORGE M (PA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:M
Last Name:MATA-VARGAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1695 SEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-2320
Mailing Address - Country:US
Mailing Address - Phone:831-578-2148
Mailing Address - Fax:
Practice Address - Street 1:799 FRONT ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-3017
Practice Address - Country:US
Practice Address - Phone:831-678-0881
Practice Address - Fax:831-678-2803
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21447363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical