Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013478304 |
---|---|
Provider Name | Genesis Vargas |
First Address | Whittier, CA 90606-1943 |
Second Address | South El Monte, CA 91733-3543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2019 |
Last Update Date | 20/09/2021 |