Healthcare Provider Details

I. General information

NPI: 1841321932
Provider Name (Legal Business Name): VIRGINIA VERONICA AGCAYAB MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 VISTA WAY SUITE 258
OCEANSIDE CA
92056-4565
US

IV. Provider business mailing address

2110 EDINBURG AVE
CARDIFF BY THE SEA CA
92007-1805
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1480
  • Fax: 760-435-9472
Mailing address:
  • Phone: 760-758-1480
  • Fax: 760-435-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC32750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: