Provider Demographics
NPI:1831112051
Name:VARGAS, ROGER STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:STEVEN
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1310 PRENTICE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3384
Mailing Address - Country:US
Mailing Address - Phone:707-433-5511
Mailing Address - Fax:
Practice Address - Street 1:1310 PRENTICE DR
Practice Address - Street 2:SUITE E
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3384
Practice Address - Country:US
Practice Address - Phone:707-433-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G781400Medicaid
CA00G781400Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER