Basic Information
| Provider Information | |||||||||
| NPI: | 1700317526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | LORENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11731 TELEGRAPH RD STE K | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906706815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11731 TELEGRAPH RD STE K | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906706815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | LMFT135408 | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.