Provider Demographics
NPI:1649451550
Name:DEL TORO VARGAS, LUCIANO (MD)
Entity type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:
Last Name:DEL TORO VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUCIANO
Other - Middle Name:
Other - Last Name:DEL TORO VARGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1920 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3414
Mailing Address - Country:US
Mailing Address - Phone:310-319-4700
Mailing Address - Fax:310-453-5106
Practice Address - Street 1:1920 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3414
Practice Address - Country:US
Practice Address - Phone:310-319-4700
Practice Address - Fax:310-453-5106
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine