Healthcare Provider Details

I. General information

NPI: 1679428577
Provider Name (Legal Business Name): CARLOS JOSUE DIMAS-VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44093 S GRIMMER BLVD
FREMONT CA
94538-6382
US

IV. Provider business mailing address

1236 145TH AVE
SAN LEANDRO CA
94578-3402
US

V. Phone/Fax

Practice location:
  • Phone: 510-284-7057
  • Fax:
Mailing address:
  • Phone: 510-695-9987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: