Provider Demographics
NPI:1841010097
Name:VARGAS, ASHLIE CORAL (VAN)
Entity type:Individual
Prefix:
First Name:ASHLIE
Middle Name:CORAL
Last Name:VARGAS
Suffix:
Gender:F
Credentials:VAN
Other - Prefix:
Other - First Name:ASHLIE
Other - Middle Name:CORAL
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:VAN
Mailing Address - Street 1:9744 AERO DR
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4708
Mailing Address - Country:US
Mailing Address - Phone:323-427-6792
Mailing Address - Fax:
Practice Address - Street 1:9744 AERO DR
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4708
Practice Address - Country:US
Practice Address - Phone:323-427-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver