Healthcare Provider Details

I. General information

NPI: 1609055755
Provider Name (Legal Business Name): JEANET VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 20TH ST
LONG BEACH CA
90806-5418
US

IV. Provider business mailing address

2114 MYRTLE AVE
LONG BEACH CA
90806-4831
US

V. Phone/Fax

Practice location:
  • Phone: 562-218-4095
  • Fax:
Mailing address:
  • Phone: 310-940-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW62613
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: