Provider Demographics
NPI:1801542964
Name:VARGHESE, JOSEPH T
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:T
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 HAYWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9039
Mailing Address - Country:US
Mailing Address - Phone:916-256-9609
Mailing Address - Fax:
Practice Address - Street 1:3169 HAYWOOD PL
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-9039
Practice Address - Country:US
Practice Address - Phone:916-256-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT02011055246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty