Healthcare Provider Details

I. General information

NPI: 1831434893
Provider Name (Legal Business Name): LUZ ADRIANA VARGAS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 E BROWN AVE
FRESNO CA
93703-2070
US

IV. Provider business mailing address

1250 SMITH ST
KINGSBURG CA
93631-2216
US

V. Phone/Fax

Practice location:
  • Phone: 559-304-2732
  • Fax:
Mailing address:
  • Phone: 559-326-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: