Healthcare Provider Details

I. General information

NPI: 1295084648
Provider Name (Legal Business Name): ALFRED VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

9449 IMPERIAL HWY
DOWNEY CA
90242-2814
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number122954
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: