Basic Information
| Provider Information | |||||||||
| NPI: | 1841321932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGCAYAB | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | VERONICA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 EDINBURG AVE | ||||||||
| Address2: | |||||||||
| City: | CARDIFF BY THE SEA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920071805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607581480 | ||||||||
| FaxNumber: | 7604359472 | ||||||||
| Practice Location | |||||||||
| Address1: | 3605 VISTA WAY | ||||||||
| Address2: | SUITE 258 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607581480 | ||||||||
| FaxNumber: | 7604359472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 08/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC32750 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.