Healthcare Provider Details

I. General information

NPI: 1992365647
Provider Name (Legal Business Name): BRYANT VARGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 RAMONA EXPRESSWAY, SUITES 1-3
PERRIS CA
92571-7014
US

IV. Provider business mailing address

85 E. RAMONA EXPRESSWAY, SUITES 1-3
PERRIS CA
92571-7014
US

V. Phone/Fax

Practice location:
  • Phone: 951-349-4195
  • Fax: 951-490-0123
Mailing address:
  • Phone: 951-349-4195
  • Fax: 951-490-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: