| Doctor Name: | MS. PETRA VERGARA |
| NPI Number: | 1710387766 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.A |
| License Number: | |
| Business Practice Address: | 7038 Owensmouth Ave Canoga Park, CA - 913033198 |
| Business Phone Number: | 8183478565 |
| Business Fax Number: | |
| Mailing Address: | 9850 Zelzah Ave Apt 207, NORTHRIDGE |
| State: | CA |
| Postal Code: | 913254628 |
| Phone Number: | 2132209470 |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2014 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |