Individual
CARLOS VARGAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17175 GRAY PINE PL, SAN BERNARDINO, CA 92407-1504
(909) 908-7775
Mailing address
17175 GRAY PINE PL, SAN BERNARDINO, CA 92407-1504
(909) 908-7775
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
760459
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
Enumeration date
09/13/2024
Last updated
09/13/2024
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