Provider Demographics
NPI:1124758206
Name:VARGAS, MARIA DE LOS ANGELES (LMT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4815
Mailing Address - Country:US
Mailing Address - Phone:909-471-2945
Mailing Address - Fax:
Practice Address - Street 1:373 E 11TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4815
Practice Address - Country:US
Practice Address - Phone:909-471-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist