Provider Demographics
NPI:1356332936
Name:VARGAS, ALEXANDER D (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:D
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5010
Mailing Address - Country:US
Mailing Address - Phone:562-869-4567
Mailing Address - Fax:562-869-4560
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5010
Practice Address - Country:US
Practice Address - Phone:562-869-4567
Practice Address - Fax:562-869-4560
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262081Medicaid
CA0252450002Medicare NSC
CAA26208AMedicare PIN
CAA83343Medicare UPIN