Healthcare Provider Details

I. General information

NPI: 1467906032
Provider Name (Legal Business Name): JENNIFER VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S GAREY AVE
POMONA CA
91766-5222
US

IV. Provider business mailing address

7184 ALMERIA AVE
FONTANA CA
92336-5034
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-8088
  • Fax:
Mailing address:
  • Phone: 626-393-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: