Provider Demographics
NPI:1447881073
Name:VARGAS, EDGAR-ALBERTO JR
Entity type:Individual
Prefix:
First Name:EDGAR-ALBERTO
Middle Name:
Last Name:VARGAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 TURQUOISE ST UNIT 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1137
Mailing Address - Country:US
Mailing Address - Phone:858-220-9429
Mailing Address - Fax:
Practice Address - Street 1:860 TURQUOISE ST UNIT 130
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1137
Practice Address - Country:US
Practice Address - Phone:858-220-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other