Provider Demographics
NPI:1548362361
Name:VARGAS, JORGE H (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:H
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:12-383 MDCC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-206-6136
Mailing Address - Fax:310-206-0203
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:12-383 MDCC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1752
Practice Address - Country:US
Practice Address - Phone:310-206-6136
Practice Address - Fax:310-206-0203
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA433062080P0206X
CAA85869208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A433060Medicaid
CAWA43306AMedicare ID - Type Unspecified
CA00A433060Medicaid