Provider Demographics
NPI:1972965093
Name:VARGAS-HERNANDEZ, LUNA
Entity type:Individual
Prefix:
First Name:LUNA
Middle Name:
Last Name:VARGAS-HERNANDEZ
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 1:527 23RD AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5324
Mailing Address - Country:US
Mailing Address - Phone:510-691-6693
Mailing Address - Fax:
Practice Address - Street 1:1410 BONITA AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1909
Practice Address - Country:US
Practice Address - Phone:510-526-4765
Practice Address - Fax:510-526-2887
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270511164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse