1083340459 NPI number — MS. KATHLEEN SOLIVEN VARGAS PT

Table of content: MS. KATHLEEN SOLIVEN VARGAS PT (NPI 1083340459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083340459 NPI number — MS. KATHLEEN SOLIVEN VARGAS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGAS
Provider First Name:
KATHLEEN
Provider Middle Name:
SOLIVEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083340459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/13/2023
NPI Reactivation Date:
10/19/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95677-8350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-829-3890
Provider Business Mailing Address Fax Number:
347-829-3888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BLUE HILL PLAZA, SUITE 1509
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-839-6979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  048699-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com