Basic Information
| Provider Information | |||||||||
| NPI: | 1043699267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | YOLANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10130 E AVENUE S4 | ||||||||
| Address2: | |||||||||
| City: | LITTLEROCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935432014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183710010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11565 LAUREL CANYON BLVD. | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183615030 | ||||||||
| FaxNumber: | 8183611764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2015 | ||||||||
| LastUpdateDate: | 06/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.