Provider Demographics
NPI:1447876321
Name:ANA KAREN VARGAS
Entity type:Organization
Organization Name:ANA KAREN VARGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:664-319-7403
Mailing Address - Street 1:4492 CAMINO DE LA PLAZA STE 818
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLVD GENERAL ABELARDO L RODRIGUEZ 10 STE 306 ZONA URBAN
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-319-7403
Practice Address - Fax:619-363-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty