Healthcare Provider Details

I. General information

NPI: 1326933342
Provider Name (Legal Business Name): MRS. SUSAM ANDREA VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 165
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 165
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4233
  • Fax:
Mailing address:
  • Phone: 805-981-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN95246583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: