Provider Demographics
NPI:1184993826
Name:VERGARA, JULIEN
Entity type:Individual
Prefix:
First Name:JULIEN
Middle Name:
Last Name:VERGARA
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 1:45-138 WILLIAM HENRY ROAD
Mailing Address - Street 2:APT# D
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45-138 WILLIAM HENRY ROAD
Practice Address - Street 2:APT# D
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5813
Practice Address - Country:US
Practice Address - Phone:808-383-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide