Provider Demographics
NPI:1053011692
Name:VARGAS MARTINEZ, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:VARGAS MARTINEZ
Suffix:
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 1:762 AGUACATE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-9112
Mailing Address - Country:US
Mailing Address - Phone:805-701-4760
Mailing Address - Fax:
Practice Address - Street 1:762 AGUACATE LOOP
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-9112
Practice Address - Country:US
Practice Address - Phone:805-701-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner