Provider Demographics
NPI:1548065162
Name:KENNEDY-VARGAS, TIERA (RN,BSN)
Entity type:Individual
Prefix:
First Name:TIERA
Middle Name:
Last Name:KENNEDY-VARGAS
Suffix:
Gender:
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30650 RANCHO CALIFORNIA RD
Mailing Address - Street 2:D406 #347
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:925-200-4066
Mailing Address - Fax:
Practice Address - Street 1:30650 RANCHO CALIFORNIA RD
Practice Address - Street 2:D406 #347
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:925-351-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95082221163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse