Provider Demographics
NPI:1750469342
Name:VARGAS, VERA ANITA (PA)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:ANITA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4841
Mailing Address - Country:US
Mailing Address - Phone:951-686-9604
Mailing Address - Fax:
Practice Address - Street 1:391 WILKERSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2254
Practice Address - Country:US
Practice Address - Phone:951-943-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17237363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical