Provider Demographics
NPI:1487293999
Name:VARGAS, SERGIO (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:VARGASLOYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:23362 CAVANAUGH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4407
Mailing Address - Country:US
Mailing Address - Phone:949-697-8791
Mailing Address - Fax:
Practice Address - Street 1:23362 CAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4407
Practice Address - Country:US
Practice Address - Phone:949-697-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program