Basic Information
| Provider Information | |||||||||
| NPI: | 1922505775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 210160 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919210160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196005309 | ||||||||
| FaxNumber: | 6196554700 | ||||||||
| Practice Location | |||||||||
| Address1: | 2452 FENTON ST STE C203 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919143599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196005309 | ||||||||
| FaxNumber: | 6196554700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 04/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 55263 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 55263 | 01 | CA | PHYSICIAN ASSISTANT BOARD | OTHER |