Provider Demographics
NPI:1700451788
Name:VARGAS, DEBBIE LOREEN
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:LOREEN
Last Name:VARGAS
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 1:4920 LA SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2612
Mailing Address - Country:US
Mailing Address - Phone:951-688-4191
Mailing Address - Fax:951-688-7822
Practice Address - Street 1:6150 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-8014
Practice Address - Country:US
Practice Address - Phone:951-688-5352
Practice Address - Fax:951-688-4421
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4806183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician