Provider Demographics
NPI:1134249428
Name:VARGO, JEFFREY RAYMOND IX (PT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RAYMOND
Last Name:VARGO
Suffix:IX
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27125 SIERRA HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5429
Mailing Address - Country:US
Mailing Address - Phone:661-250-9940
Mailing Address - Fax:661-250-9959
Practice Address - Street 1:5165 MAUREEN LN
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1783
Practice Address - Country:US
Practice Address - Phone:805-523-8076
Practice Address - Fax:805-523-8796
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15002Medicare ID - Type UnspecifiedPROVIDER ID
CAW15002BMedicare ID - Type UnspecifiedPROVIDER ID
CAW15002EMedicare ID - Type UnspecifiedPROVIDER ID