Provider Demographics
NPI:1922505775
Name:VARGAS, CHRISTOPHER B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:B
Last Name:VARGAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210160
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-0160
Mailing Address - Country:US
Mailing Address - Phone:619-600-5309
Mailing Address - Fax:619-655-4700
Practice Address - Street 1:2452 FENTON ST STE C203
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3599
Practice Address - Country:US
Practice Address - Phone:619-600-5309
Practice Address - Fax:619-655-4700
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55263363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55263OtherPHYSICIAN ASSISTANT BOARD