Healthcare Provider Details

I. General information

NPI: 1821393026
Provider Name (Legal Business Name): NASTASSJA RACHELLE VARGAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 UNION AVE # 100
BAKERSFIELD CA
93307-1050
US

IV. Provider business mailing address

8775 AERO DR STE 238
SAN DIEGO CA
92123-1756
US

V. Phone/Fax

Practice location:
  • Phone: 661-631-1483
  • Fax: 661-631-8665
Mailing address:
  • Phone: 619-930-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: