Active NPI
Jose Vargas, PA
- Physician Assistant
- Canoga Park, CA
National Provider Identifier
1396903647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA11074
- Practice address
- 20440 Sherman Way
Canoga Park, CA 91306-3110 - Phone
- (818) 346-2395
- Fax
- (818) 346-4591
- NPI assigned
- May 22, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA11074 | CA | Primary |
Addresses
Primary practice location
20440 Sherman Way
Canoga Park, CA 91306-3110
Mailing address
20440 Sherman Way
Canoga Park, CA 91306-3110
Phone (818) 346-2395
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA11074 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11074 | CA | MD | Mental Health Counselor |
| PA11074 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jose Manuel Gonzalez-Diaz | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Canoga Park, CA
- NPI 1467517557
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211414400000",
"number": "1396903647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20440 SHERMAN WAY",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "913063110",
"telephone_number": "818-346-2395",
"fax_number": "818-346-4591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20440 SHERMAN WAY",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "913063110",
"telephone_number": "818-346-2395",
"fax_number": "818-346-4591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARGAS",
"first_name": "JOSE",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-22",
"last_updated": "2008-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA11074",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PA11074",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canoga Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.